European Urology Today

Transcription

Official newsletter of the European Association of Urology 1-7
28th Annual EAU Congress
Hemorrhagic cystitis
Including list of award winners
Challenges in treatment
9
Prof. Maurizio Brausi
Vol. 25 No.2 - March/May 2013
Neobladder and continent
urinary diversion
16
Expert’s view
Prof. Richard Hautmann
More collaborative links, practical use of research findings
Recurring messages in Milan: Collaboration and using research discoveries
By Joel Vega
Closer links across urological specialties and medical
disciplines and the practical use of recent research
findings in everyday clinical practice are among the
recurring messages given by experts, opinion leaders
and speakers during the 28th Annual EAU Congress
held in Milan, Italy.
“This meeting does not only connect us as urologists
but also provide the venue for us to achieve more and
work closely across disciplines, specialities and
borders. Together, we can make progress,” said EAU
Secretary General Prof. Per-Anders Abrahamsson (SE)
in his welcome remarks at the opening ceremony
held last March 15 in Milan, Italy.
Abrahamsson not only noted the EAU’s role as a
representative organisation but also its capacity to
expand the reach of urology to other disciplines and
the crucial function it performs to promote scientific
research and professional development. The Scientific
Programme of the five-day congress reflected the
EAU’s aim to provide a fitting venue for urologists in
and outside Europe, their partners from other medical
disciplines and the industry to effectively collaborate
for research and clinical work.
With the first day presenting the views of urological
associations from around the world at the Urology
Beyond Europe, and the meeting of prostate cancer
experts at the Conference on Prostate Cancer
Prevention, the congress emphasised quality scientific
presentations that aim to carefully examine
controversies, debates and other issues in urooncology and urological diseases.
A case discussion on male urinary incontinence
Urology Award to Prof. Urs Studer (CH) (See inside
pages for a complete list of awardees).
In prostate cancer research, experts said the
immediate need is for a direct or practical application
of research discoveries in genetic markers.
“Researchers understand that it is difficult to translate
even excellent basic research to the clinical lab. And
even when that research gets to the clinical lab, the
complexity and the costs of a test can limit its use
because today healthcare costs are going up very
rapidly,” said Dr. Harry Rittenhouse (USA), who spoke
on urinary PCA3 a t the prostate cancer prevention
meeting.
Core urology issues
With four plenary sessions held during the congress,
participants have a comprehensive view of urological
issues ranging from core urology topics, urooncology, reconstructive, andrology, stones, female to
At the opening ceremony the EAU honoured its
paediatric urology, to name a few. The first session
pioneering members and opinion leaders and
examined paediatric urology and the ageing patient
awarded promising young urologists. Among the top with speakers providing key messages on the benefits
honours given were the Willy Gregoir Medal to Prof.
and drawbacks of surgery for hypospadias, the use of
Clement Claude Abbou (FR) and the EAU Innovators in artificial mesh implants in women with incontinence,
“Quality is the major goal. We cover more topics every
year, but you have to do that without losing sight of
the quality,” said Prof. Arnulf Stenzl (DE), Chairman of
the Scientific Congress Office in an earlier interview.
insights in treating vesicoureteral reflux (VUR) and the
value of providing personalised management for
ageing patients with co-morbidities and functional
problems.
possible screening as long as they know the benefits
and drawbacks of screening tests. Tom Hudson (IE) of
the patient’s group Europa Uomo presented the
patient’s view.
Insights on the optimal treatment for upper urinary
tract cancers were presented and discussed in Plenary
Session 2 with topics such as the benefit of
lymphadenectomy, the pros and cons of organsparing approaches and the role of endoscopic
treatment, among other issues. Meanwhile, the
session on the third day tackled lower urinary tract
management with speakers examining urodynamic
assessment in current practice, a lively case discussion
on surgical options for male urinary incontinence and
practical therapies for LUTS.
“My appeal to all physicians is for us to understand
each other. Please don’t use language that we don’t
understand since what we need is a simple and clear
explanation, which is of crucial importance,” Hudson
said. “We appreciate your fantastic efforts to find cure
and treatment, but cut the confusion if I may put it
bluntly,” he said referring to the continuing debate on
PSA screening, particularly in the US.
The latest data on PDE5 inhibitors, beta-3 agonists,
botuliniumA toxin, and combination therapies were
presented and speakers emphasised the role of
urologists to take the lead.
“Urologists need to maintain control over this
complex and multifaceted condition,” said Prof. Chris
Chapple (GB), as he noted that more research is
needed despite the radical changes in the medical
treatment of LUTS in recent years.
At the joint EORTC-ESUR Section Meeting
“The EAU, the patients group
Europa Uomo and the ERSPC all
presented perspectives which added
more nuance to the (PCa screening)
debate…”
Section Meetings
Aside from the plenary sessions, seven Section
Meetings were held with the day-long live surgeries
attracting a full attendance. Ten live surgeries were
transmitted to the congress auditorium with running
commentary by the operating doctors, and annotated
by moderators in the session hall.
The closing plenary brought to the fore new insights
in much debated topics such as prostate cancer
screening and treating metastatic and castration
resistant prostate cancer (PCa). Also presented were
the EAU’s new guidelines on ethics of live surgery
and a preview report by the prostate cancer
prevention consensus group.
Sixteen Thematic Sessions were also held over two
days and covered various topics in urology such as
minimal invasive surgery, urological cancers, surgical
complications, neurourology, challenging cases to
pain management, to name a few.
The EAU’s view on PCa screening through PSA testing
was presented by Abrahamsson who noted the
importance of not denying well-informed men a
At the closing session, Abrahamsson invited the
audience to Stockholm for the 29th Annual EAU
Congress to be held from April 11 to 15, 2014. Next
year’s congress will be the third to be held in Sweden
after the well-attended congresses in 1999 and 2009.
Post-congress reflections
Picking up what occurs below the radar is equally crucial
At the 28th Annual EAU Congress in Milan, the
Scientific Congress Office has again presented a
programme whose format, coverage and contents
reflected the intense and careful preparations which
are necessary for a high quality international meeting.
With around 13,000 participants, including the more
than 10,000 delegates to the EAU/EAUN congresses,
the session halls were filled to capacity during the live
surgeries, the International Conference on Prostate
Cancer Prevention and the Plenary and Thematic
Sessions. Earnest discussions marked the seven
Section Meetings, the abstract sessions, and the
Urology Beyond Europe which offered the
perspectives of colleagues from outside the region.
Certainly, we can say that we do not only have an
international reach in terms of coverage, but also
presented current views and trends in various
regions. The international meeting on prostate cancer
prevention, for instance, showed the dynamics of
offering an international platform where manifold
viewpoints are carefully examined.
In Plenary Session 4, Keith Parsons of the Guidelines
Office, presented the EAU policy for live surgery,
touching on ethical issues and safety guidelines which
is a first in the urological community. In the same
session we heard the key messages on recurring
topics and controversies such as the PCa screening
debate. The EAU, the patients group Europa Uomo
and the ERSPC all presented perspectives which
added more nuance to the debate than ever before.
Thus, the overarching theme is one that many will
agree on: for us to offer optimal care we need to
effectively collaborate within and outside urology.
Moreover, to fully benefit from the discoveries of
research we have to find the practical uses of these
findings in everyday clinical practice. Chris Chapple
led a session on lower urinary tract management,
March/May 2013
Prof. Manfred Wirth
Editor-in-Chief
emphasising the importance of a concerted effort
from both medical scientists and the industry to work
together on clinical trials and research breakthroughs.
At the General Assembly Meeting, we have also
confirmed that for the EAU to further advance we
need to strengthen the formal ties with our medical
and non-medical partners. The danger for
organisations is to evolve into monolithic systems,
with a tendency to ‘macro-manage’ processes whose
very nature are often local or circumscribed.
We are aware that some of the developments with the
most significant impact often occur in small moments
or increments, taking place just below the radar.
Our organisation aims to precisely detect these
seemingly mundane but steady gains by keeping our
ears close to the ground. We encourage you to give
your comments by logging in to the EAU website and
use the email form and send us your suggestions for
improvement.
In this issue you will find, as customary after the
annual congress, the summary reports of some of the
highlights discussed in Milan. There are photos,
opinion articles and the regular editorial departments.
For those who have missed the congress, it will not be
possible to report all the messages, but with this
edition you will have a bird’s eye view of the manifold
issues that impact on urology.
The annual congress is not merely a gathering of
like-minded individuals nor is it a place to heighten old
scores and scientific disputes. Rather, our congress
serves as a direct link to ideas, to the potentially crucial
and to what may occur under the radar, and whose
value remains to be weighted in the days ahead.
1
Highlight Session 1: Prostate disease
What is new in BPH assessment and treatment
Dr. Aurélien
Descazeaud
Limoges Academic
Hospital
Dept. of Urology
Limoges (FR)
aurelien.
descazeaud@
chu-limoges.fr
Prostate disease includes benign and malignant
disease. As prostate cancer was extensively covered
in other highlight sessions, this article focuses on
benign prostate hyperplasia (BPH).
What are the key messages on BPH evaluation and
treatment to take home from the 2013 EAU meeting?
Although almost all abstracts selected contained
interesting data, we apologise to the authors who are
not cited here due to space constraints.
How to evaluate bladder outlet obstruction (BOO)?
The question is still unresolved.
In men with acute urinary retention, lower age, large
drained volume, and severe pain were independent
predictive factors of BOO (Rom et al., #991). Suzuki et
al. (#998) suggested combining several values
obtained from transrectal ultrasonography to predict
BOO, including transition zone index, intravesical
prostatic protrusion, and resistive index. Similarly,
Ciudin and coll. (#993) considered that the joint
measurements of bladder wall thickness, middle lobe
protrusion, and prostate volume might replace
urodynamics in the evaluation of BOO.
Several studies attempted to determine predictive
factors of successful therapy in BPH. High BMI was
associated with failure of surgical treatment (Wilder
et al., #989). In addition, patients with predominant
nocturia were less likely to improve their symptoms
following medical or surgical treatment of BPH (Cäkir
et al., #407). In a 22-million population-based
analysis including 34,000 patients operated by TURP,
smaller resected prostate weight could be at higher
risk of continual medication or reoperation (Lin et al.,
#515).
The use of 5 Alpha reductase inhibitors (5ARI) is still
debated. First, in the COMBAT study, combination
therapy resulted in improvements in nocturia
compared with monotherapies (Reardon et al.,
#1095). Association of 5ARI and tadalafil was
evaluated in two studies, and showed that the
association was safe and efficient in both lower
urinary tract symptoms (LUTS) and erectile
dysfunction (Park et al., #1092; Hauk et al., #1096). In
a randomised study including 142 patients, Pastore et
al. (#517) found that dutasteride for six weeks before
transurethral resection of the prostate reduced
surgical bleeding. Finally, statin use was associated
with a mild prostate volume reduction only in patients
not taking 5ARI (Cho et al., #409).
Several studies assessed the role of antimuscarinics
therapy in BPH. Combination therapy with tamsulosin
OCAS (oral controlled absorption system) formulation
plus solifenacin was found to offer significant
improvements in IPSS quality of life index versus
tamsulosin OCAS alone in men with LUTS related to
BPH who had both voiding and storage symptoms
(Napier et al., #1089). Liao & coll. (#1090) evaluated
first-line antimuscarinic monotherapy in patients with
enlarged prostates. Four parameters were found
predictive of successful treatment including:
• Predominant storage symptoms
• No elevated post-void residual volume
• Higher maximum urinary flow rate (Qmax).
• Smaller prostate volume
In Gotoh’study (#404), combination therapy of
imidafenacin and tamsulosin in patients with
overactive bladder related to BPH had greater
improvements in OAB symptoms and in nocturia
compared to those treated by tamsulosin alone.
Editor-in-Chief
Prof. M. Wirth, Dresden (DE)
Section Editors
Dr. A. Cestari, Milan (IT)
Mr. Ph. Cornford, Liverpool (GB)
Prof. O. Hakenberg, Rostock (DE)
Prof. P. Meria, Paris (FR)
Prof. J. Rassweiler, Heilbronn (DE)
Prof. O. Reich, Munich (DE)
Prof. Th. Roumeguère, Brussels (BE)
J.L. Vasquez, Frederiksberg (DK)
Regarding lasers, Netsch & coll. (#636) reported an
interesting series of 56 patients under oral
anticoagulation including aspirin, clopidogrel and
coumadin, who were treated by thulium laser for
BPH. Five patients required early reoperation, and
four received blood transfusion. This highlights the
fact that BPH on OA patients is at high bleeding risk,
even using laser treatment. In another study, 120 &
180 watt Greenlight ® lasers were compared. The
later system reduced mean operative time from 80
min. to 53 min. and was safe (Hueber et al., #638).
Some experimental techniques were reported this
year. First, mirabegron, a novel Beta3 adreno receptor
agonist might be efficacious on storage symptoms in
patients already treated by alpha blocker therapy
(Ogura et al., #1091). According to phase 2 studies,
NX1207, a pro-apoptotic protein delivered by
intraprostatic injection, might be safe and effective in
the treatment of LUTS related to BPH; a phase-3 study
is ongoing in the United States (Gemmell et al., #626).
Meditate ® is a temporary implantable nitinol device
which was tested in 19 BPH patients. This might
provide effective BOO relief (Porpiglia et al., #630).
The Urolift ® device, which is transurethraly
implanted into the prostate might also be effective in
BPH patients. This can be placed under local
anaesthesia (Amend et al., #629). Campos Pinheiro
and colleagues (#628) reported a series of 365
consecutive patients treated by prostatic artery
embolisation for LUTS related to BPH. This outpatient
technique might be particularly effective in patients
with prostate larger than 100 ml. The authors
reported one case of bladder wall ischemia.
Summary highlights
The following are the summary conclusions:
• Predominance of obstructive symptoms, high
prostate volume, low Qmax and the use of several
ultrasonography parameters might help identify
patients with BOO;
• Preliminary studies showed that the association of
5ARI and tadalafil might be safe and efficient;
• Antimuscarinics agents, alone or in association
might be useful in BPH, especially in patients in
whom LUTS might not be only prostate related;
• The 180 watt Greenlight ® laser appears to be
faster than the 120 watt version;
• BPH surgery in oral anticoagulation patients
remains at high-risk, even using laser devices; and
• Finally, some emerging techniques might be
promising, but are still experimental.
Fig. 1: Urolift ® device (Amend et al., #629)
Impressions from
Special Guest Editor
Prof. F. Montorsi, Milan (IT)
Founding Editor
Prof. F. Debruyne, Nijmegen (NL)
Editorial Team
H. Lurvink, Arnhem (NL)
E. Starkova, 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
[email protected]
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.
2
March/May 2013
Highlight Session 1: Reconstruction
Reconstruction urology is an evolving field with new aspects emerging
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Asst. Prof. Cristian
Surcel
Fundeni Clinical
Institute
Dept. of Urology
Bucharest (RO)
[email protected]
At the 28th Annual EAU Congress many thoughtprovoking abstracts were presented on
reconstruction and which addressed various
aspects, ranging from stem cells to robotic urinary
diversions.
Unfortunately not all authors are included in this
article, since less than 5% of the papers will be
discussed in this short review. The selection of papers
was done according to their clinical relevance,
number of patients included in the study,
reproducibility of results and, of course, and their
innovative or pioneering approach.
This year in Milan, 51 abstracts regarding various
aspects of reconstruction were accepted, as seen in
Table 1.
Tissue engineering was a very hot topic in this year’s
congress, accounting for more than 30% of the
abstracts on reconstruction.
Roelofs et al. (#870) investigated whether
neurological damage can be prevented and skin
regeneration can be improved, by covering an
experimental spina bifida lesion on fetal lambs with a
growth factor loaded scaffold (VEGF and FGF-2). They
showed that suturing or gluing the scaffold on the
spina bifida lesion can improve the neurological
outcome and significantly diminish the urinary
leakage.
For the surgical treatment of long and complicated
urethral strictures, bioartificial matrix-stabilized
urothelium offers an innovative therapeutic option for
urethral reconstruction. Collagen matrices increase
the stability of cell-based implants and promote cell
viability and proliferation of urothelial cells. Vaegler
et al. (#248) investigated various stabilization
strategies of tissue-engineered urothelium. Collagen
Cell Carrier (CCC) seeded with autologous urothelial
cells was implanted in mini-pigs after induction of a
urethral stricture. The seeded CCC displayed excellent
stability characteristics and suturability when
manipulated and the urothelium-matrix transplants
integrated properly into the host tissue without any
sign of visible inflammation.
Transplantation of mesenchymal stem cells can be
Table 1: Overview of
selected abstracts on
reconstruction
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used for the regeneration of the damaged cells of
corpora cavernosa. Song et al. (#325) examined the
differentiation of human mesenchymal stem cells
cultivated on the surface of nanofibrous meshes
(nano-hMSCs) into neuron-like cells and their capacity
to recover the erectile function using their
transplantation around the injured cavernous nerve
(CN) of rats. They prove that Nano-hMSCs
differentiated into neuron-like cells and their
transplantation on damaged corpora cavernous
improves the erectile function of the rats with
cavernous nerve injury.
Bladder neck sclerosis is a severe complication of
transurethral resection of the prostate (TURP) with an
increasing incidence in the laser/vaporization era.
Endoscopic resection or incision of bladder neck is
usually successful in management of such cases, but,
in some patients, even repeated endoscopic
procedures fail to resolve the sclerosis. Sayedahmed
et al. (#867) performed a retrospective evaluation of
17 patients who underwent a modified Y-V plasty of
the bladder neck post TUR-P.
Difference to the standard Y/V-plasty was a T-shaped
incision of the anterior bladder wall. With this
technique two vascularised flaps were created, which
offer the possibility to reconstruct a wide bladder
neck and also, the anterior prostatic urethra. They
evaluated Q max, residual urine volume,
questionnaires (IPSS, SF-8 and ICIQ-SF) to all patients
before and after the Y-V plasty. After a mean
follow-up of 39.2 months, the mean Q max increased
from 2.3 ml/s to 19.3 ml/s and 94.1% of patients
reported satisfactory micturation with significant
improvement of quality of life. In conclusion, the Y-V
Plasty of the bladder neck sclerosis after TURP and
failed endoscopic treatment represents a viable option
with a high success rate.
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Stricture recurrence after urethroplasty with buccal
mucosal graft (BMG) represents a challenge for
reconstructive surgeons. Pandey et al. (#790)
addressed this issue in a prospective study and
concluded that a short-length bridging at the
transplantation site can be treated successfully with
urethrotomy or dilatation in more than 50% of cases.
Buccal mucosa graft can be used once more for long
recurrent strictures, but the success rates are less than
after primary reconstruction.
Milan section:
More collaborative links, practical use of
research findings. . . . . . . . . . . . . . . . . . . . . . 1
Post-congress reflections . . . . . . . . . . . . . . . . 1
Highlight Session 1: Prostate disease . . . . . . . 2
Highlight Session 1: Reconstruction . . . . . . . . 3
Highlight Session 2: Andrology. . . . . . . . . . . . 4
Highlight Session 2: Oncology. . . . . . . . . . . . . 4
Overview of prizes and awards. . . . . . . . . . 5-7
Ten questions: John Wickham. . . . . . . . . . . . . 8
London hosts 3rd ESGURS-ESAU meeting. . . . 8
Sexual Medicine takes a step forward
with qualifying exam. . . . . . . . . . . . . . . . . . . 9
Hemorrhagic cystitis: Etiology and
treatment. . . . . . . . . . . . . . . . . . . . . . . . . 9-10
Robot-assisted radical cystectomy (RARC) with total
intracorporeal diversion with an ileal neobladder is a
challenging procedure in urology, demanding high
levels of experience. Tyritzis et al. (#1035) presented
the largest single center series to date of this
operation, focusing on complications and oncological
outcomes. Between 2002 and 2012, a total of 67 RARC
with intracorporal Studer neobladder were
performed. Despite their short mean follow-up time
of 27months, they showed good oncological
outcomes, but the mean operating time, complication
rates (immediate and late), median hospitalization
time remained significantly high.
Clinical Challenge. . . . . . . . . . . . . . . . . . . . . . 11
The authors concluded that after 10 years of RARC
with total intracorporeal urinary diversion, the
technique is still under refinement. Centers need to
standardise all the steps of the operation in an effort
to decrease complication rates and to optimise
oncological outcomes.
Live surgical events: Skills or thrills?. . . . . . . 18
To conclude, reconstruction urology is an evolving
field. Every year, new aspects come to light and
challenge current clinical practices. I congratulate and
encourage all the authors who have submitted their
work and to continue with their efforts.
Key articles from international medical
journals. . . . . . . . . . . . . . . . . . . . . . . . . . 12-13
EBU section:
EBU Certification Programme Prague. . . . . . 14
Coimbra’s Residency Training gains EBU
certification . . . . . . . . . . . . . . . . . . . . . . . . . 14
ERUS 10th Anniversary Meeting. . . . . . . . . . 15
Neobladder and continent cutaneous
diversion after RC. . . . . . . . . . . . . . . . . . . . . 16
USANZ Trainee Week . . . . . . . . . . . . . . . . . . 17
ESU section:
European Urology Forum 2013 . . . . . . . . . . . 19
Optimising management of non-muscle
invasive TCC. . . . . . . . . . . . . . . . . . . . . . . . . 20
YUO section:
Creating a network of professional contacts. .
Endourology fellowship in Pakistan . . . . . . .
A call for active support. . . . . . . . . . . . . . . .
Milan Congress: Clockwork efficiency. . . . . .
Residents’ Day: Tips and challenges. . . . . . .
22
22
23
23
23
EULIS section:
Open stone surgery in 2013. . . . . . . . . . . . . . 24
Endourology course in Torino, Italy . . . . . . . 24
See you next year in Stockholm!
History Office section:
Remembering Arthur Barth (1858-1927) . . . . 25
Book reviews. . . . . . . . . . . . . . . . . . . . . . . . 26
2nd EULIS Meeting: Towards personalised
management . . . . . . . . . . . . . . . . . . . . . . . . 27
Delegates per country
Canadian Tour 2012 . . . . . . . . . . . . . . . . . . . 28
ESUT’s dynamic presence in Milan. . . . . . . . 29
Congress calendar 2013/2014 . . . . . . . . . 30-31
Who’s Who in Urology. . . . . . . . . . . . . . . . . 32
EU-ACME section:
Win a free registration to Stockholm in 2014!. 32
EU-ACME MCQ 2012 winners . . . . . . . . . . . . 32
Obituary: Mirja Ruutu. . . . . . . . . . . . . . . . . . 33
The red colour corresponds to the number of
delegates per country (the more intense the
colour, the larger the representation)
3,292
4,997
1,186
216
Total delegates EAU
9,691
March/May 2013
Mont Blanc Senior Visiting Scholarship
Programme . . . . . . . . . . . . . . . . . . . . . . . . . 34
Accrual Workshop MAGNOLIA trial. . . . . . . . 36
EAU 2012 Registrations per category
EAU members
Non EAU members
Residents EAU member
Residents non EAU member
Between bench and clinic. . . . . . . . . . . . . . . 34
Nurses EAUN member
Nurses non EAUN member
Total delegates EAUN
186
219
405
Total delegates EAU/EAUN
Congress10,096
Exhibitors2,349
Press173
Accompanying Persons
270
Total participants
12,888
Prostate and kidney dilemmas. . . . . . . . . . . 36
www.reviews. . . . . . . . . . . . . . . . . . . . . . . . 37
Tübingen hosts joint meeting. . . . . . . . . . . . 37
EAUN section:
Overview report: 14th International EAUN
Meeting. . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
EAUN Fellowship addresses patient safety. . 39
A forward-looking urology practice . . . . . . . 39
3
Monday, 18 March, Highlight Session 2: Andrology
Sessions examine basic science and clinical aspects within andrology
Dr. Mikkel Fode
Herlev Hospital
Dept. of Urology
Herlev (DK)
mikkelfode@
gmail.com
The 28th Annual EAU Congress presented many high
quality andrology abstracts, and it is a privilege for
me to highlight some of the studies which focused on
basic science in male infertility and sexual dysfunction
as well as the clinical aspects of men’s sexual health.
Two major aspects regarding male infertility were
discussed, namely epigenetics and lifestyle factors.
Epigenetics relates to molecular modifications of DNA
and one aspect that has been shown to be of
importance is the replacement of histones by
protamine late in the spermatogenesis. An abstract by
Rogenhofer et al. (#27) investigated ejaculated semen
from 306 men from infertile couples and 32 healthy
controls. Here, an abnormal ratio of protamine 1:
protamine 2 predicted fertilization rates with artificial
reproductive techniques, with the most aberrant ratios
leading to the worst results. Larger studies are
underway to further illuminate this issue.
Regarding lifestyle issues and fertility, two studies by
Bechara et al. (#29) and Silva et al. (#30) showed
morphological testicular changes and reduced sperm
concentration in hypertensive rats and rats fed with a
diet of saturated fat, respectively. Interestingly, these
changes were ameliorated by enalapril in hypertensive
rats and no adverse effects were seen when saturated
fats were replaced by unsaturated fats.
In men’s health, Zacharakis et al. (#129) compared
the results of early implantation of a penile prosthesis
after priapism and late implantation several months
after the incident. The study described an increased
ease of dilation of the corpora in the early treatment
group and a reduced need for revision surgery.
Furthermore, there was no penile shortening in the
early implantation group compared to 40% in the late
implantation group. The authors recommended that
implants are implanted as quickly as possible if a case
of refractory ischemic priapism has lasted beyond 48
hours.
Another study (Appel et al., #131) reported on low
intensity extracorporeal shock-wave therapy (ESWT).
The authors evaluated results up to eight months after
treatment in 155 patients from previous trials. More
than 50% of patients still had clinically significant
improvements in erectile function compared to
baseline at this point. The effect was best in patients
with mild to moderate ED. A lengthy discussion after
the presentation underlined that ESWT is still a
controversial treatment but it is clear that evidence
continues to accumulate.
The final ED topic is the concept of penile
rehabilitation after radical prostatectomies, which also
led to some discussion at the conference.
Unfortunately, 16 years after our Milan host, Prof.
Francesco Montorsi, published the first paper on the
topic, there is still no conclusive evidence regarding
the optimal treatment protocol. This was illustrated in
a questionnaire study by Bannowsky et al. (#127),
which showed that 262 German urologists used no
less than 39 different rehabilitation protocols.
Another hot topic in andrology is late onset
hypogonadism. At the EAU meeting we saw an
observational study of 850 hypogonadal men who
were treated with testosterone injections for up to five
years (Yassin et al., #207). The mean BMI dropped an
impressive 7.4 points which is more than generally
seen in such studies. It is important to note that it was
an observational study not controlled for lifestyle
modifications. However, it does illustrate some of the
potential benefits of testosterone treatment. At the
other end of the spectrum are the potential harms,
and although this has recently been intensely
questioned, the main concern remains prostate cancer.
Arguments are heated on both sides but the fact
remains that high quality studies are lacking regarding
safety and harm.
from previous non-randomized trials and they indicate
that varicocelectomies are relevant in the treatment of
hypogonadism whenever the two conditions co-exist.
The congress presented a number of very interesting
studies regarding regenerative medicine and
premature ejaculation. A study by Castiglione et al.
(#324) represented the first attempt to treat active
Peyronie’s disease in a rat model with adipose
To address the concerns, a large group of much
esteemed colleagues have initiated a multicenter study tissue-derived stem cells. The stem cell treatment was
shown to prevent penile fibrotic changes and to
(n=999) designed specifically to investigate the
improve erections (Figure 1). The full study was
development of prostate cancer with long-term
published in the March edition of European Urology
testosterone use. An abstract by Rosen et al. (#211)
and the group is conducting further studies to
provided a very nice characterization of the
investigate whether stem cells may be of benefit in the
participants. However, the real value of the study will
chronic phase of the disease.
become evident in the next few years when
longitudinal and prospectively collected data on the
effects of testosterone treatment are published.
Another study by La Croce et al. (#328) concerned
premature ejaculation. This very innovative study
Another testosterone-related study completely
confirmed the presence of an endocannabinoidregulatory enzyme called “fatty acid amide hydrolase”
bypassed these safety discussions by attempting to
treat the cause of the hypogonadism. In the study by
in ephithelial cells of both animal and human seminal
Afoko et al. (#212), the authors managed to randomize vesicles. Interestingly, inhibition of this enzyme-delayed
59 middle aged patients with varicoceles and
apomorphine induced ejaculation in rats by almost 15
symptoms of hypogonadism to varicocelectomy or
minutes from about five to around 20 minutes. This
observation. In the no-treatment group, the
means that the research group might have found a new
testosterone levels remained low while the mean
target for the treatment of premature ejaculation, which
value increased from 6.3 nmol/L to 10.8 nmol/L in the
has never been explored before. The effects could have
treatment group over 18 months. In addition, patients been mediated at a local level, which means that such
a treatment could be without significant side effects on
reported an improvement of their hypogonadal
the central nervous system.
symptoms. The results are in accordance with those
As can be expected many high
quality abstracts are not
highlighted here and I regret that it
is not possible to include or cite
more studies. However, full
presentations from the conference
are available at
http://www.eaumilan2013.org/.
Figure 1: Stem cells prevented fibrosis and preserved erectile function in a rat model of active Peyronie’s disease
Monday, 18 March, Highlight Session 2: Oncology
New insights in CRPC, penile cancer and nephron-sparing surgery
Prof. Axel S.
Merseburger
Clinic for Urology and
Urologic Oncology
Medical School
Hannover (DE)
Merseburger.axel@
mh-hannover.de
Urologic oncology was again a topic that drew a lot
of attention, and the highest percentage of the 1182
abstracts was on topics that directly or indirectly
covered urologic oncology.
With this high number of submitted abstracts, it is
thus impossible to cover all important investigations.
In this short review, I have chosen the studies which
are of interest and have an immediate clinical impact:
segemental ureterectomy provides oncologic and
renal functional outcomes similar to radical
nephroureterectomy. No significant difference in
cancer-specific survival was reported in this
matched-pair analysis. However, the renal function
was not superior in the organ preserved group (RNU
10.6 ml/min. vs. SNU 6.6 ml/min. p = 0.174) which
might be due to confounders such as previous
intrarenal surgery, ureter stents, etc. (Figure 1).
They also demonstrated that although the use of
abiraterone can potentially lead to an accumulation of
precursor hormones, its anti-androgenic properties
may stop precursor hormone-induced androgen
receptor (AR) activation. High concentrations of
androgen precursors can drive CRPC growth through
direct activation of overexpressed AR and not
necessarily via the result of intra-tumoural CYP17metabolism.
European Study (ZEUS) which showed no difference
in the incidence of bone metastases between the
Zometa group and control arm. Patients were
randomised between standard treatment plus
Zometa® 4 mg infusions every three months for a
total of 48 months. No difference in survival was
shown after a median follow-up of 50 months.
Zoledronic acid was expected to show its potential in
preventing hormone therapy-induced bone loss.
Rink et al. (#813) have assessed the median time from
radical nephroureterectomy to disease recurrence.
This was reported to be 12 months in the cohort of 547
assessed patients, while the median time from
disease recurrence to tumour-specific death was 10
months.
This suggests that CRPC may not rely solely on de novo
androgen synthesis. We show that abiraterone, a
CYP17A1-blocking drug that has recently been approved
in the treatment of CRPC, possesses an additional
anti-androgenic property and can block androgen
precursor-induced AR-activation at higher
concentrations than what is needed for CYP17A1 specific
inhibition. The study won the first prize for best
abstract in oncology at the 28th Annual EAU Congress.
Below are the general conclusions:
Volpe et al. (#174) reported on the first data of the
Italian prospective active surveillance (AS) trial in
small renal masses. Of the 32 included patients no
progression to metastasis or tumour-specific death
occurred. The authors concluded that AS might be an
option in selected elderly and/or comorbid patients.
Sooriakumaran et al. (#824) aimed to compare such
outcomes in a Swedish cohort treated from 1996
onwards in their large observational study. 34,515
Djajadiningrat et al. (#392) have demonstrated
men were treated for prostate cancer throughout
contemporary five-year cancer-specific survival (CSS)
Sweden with either surgery (n = 21,533) or
of penile squamous cell carcinoma patients treated at Rouffilange et al. (#96) examined the indications of
partial nephrectomy (PN) within the limits of technical radiotherapy (n = 12,982) as their first treatment
our institution and compared this with previous
feasibility. The group assessed the morbidity,
option and form the study cohort. Radiotherapy
cohorts stratified by treatment periods. The main
change was the introduction of dynamic sentinel node mortality, oncological and functional results of PN for patients generally had higher Gleason sums and
the treatment of renal tumours greater than 7 cm. PN clinical stages, were older, and had higher PSA than
biopsy (DSNB) in 1994. Despite less surgery on the
is feasible for tumours over 7 cms but has a global
patients that underwent surgery (p < 0.0001 for all
regional nodes, improvement of five-year CSS has
complication rate of 31%. Additionally, this
comparisons). Survival outcomes favored surgery, and
been seen in cN0 patients. This is probably due to
investigation found an association of a high local
for locally advanced/metastatic patients treatment
detection of microscopic disease by DSNB. The
recurrence rate of 23.5% despite negative surgical
results were similar. The only cohort in which
authors concluded that penile preserving therapies
radiotherapy had superior prostate-cancer-mortality
margins.
are increasingly performed, without jeopardizing
outcomes was those aged 65-74 with non-localised
survival.
Moll et al. (#824) reported that anti-androgenic
disease.
properties of the drug abiraterone may provide an
Klatte et al. (#575) have shown in their retrospective
Finally, Wirth presented during the closing and fourth
additional mechanism of action in blocking tumour
multicenter study (OSS-UTUC) that for the
growth of castration resistant prostate cancer (CRPC). plenary session the initial study results of the Zometa
management of ureteral urothelial carcinoma,
• The AR remains the most important target in the
treatment of CRPC;
• Nephron-sparing surgery in large renal lesion is
feasible, hence recurrence rates are high;
• Dynamic sentinel node biopsy (DSNB) in penile
cancer has resulted in less surgery on the regional
nodes and improvement of five-year CSS;
• No difference in survival was shown for Zoledronic
vs. placebo; and
• Surgery was superior compared to radiotherapy
with regards to survival in localised prostate cancer.
Figure 1: Cancer-specific survival in the study of Klatte et al.
(#575)
4
March/May 2013
Overview of prizes and awards at the 28th Annual EAU Congress
EAU Willy Gregoir Medal 2013
Opening
Ceremony
C-C. Abbou, Créteil, France
- Handed out by P-A. Abrahamsson
EAU Frans Debruyne Life Time
Achievement Award 2013
J. Breza, Bratislava, Slovakia
Friday,
15 March
EAU Crystal Matula Award 2013
P. Boström, Turku, Finland
Supported by an unrestricted
educational grant from LABORIE
- From left to right: P. Boström,
R. Laborie (LABORIE) and
P-A. Abrahamsson
EAU Hans Marberger Award 2013
J. Rassweiler, Heilbronn, Germany
Supported by an unrestricted
educational grant from KARL STORZ
GMBH & CO.KG
- From left to right: J. Rassweiler,
P-A. Abrahamsson and S. Storz
(KARL STORZ GMBH & CO.KG)
EAU Innovators in Urology Award 2013
U. Studer, Berne,
Switzerland
- Handed out by
P-A. Abrahamsson
New EAU Honorary Members
EAU Prostate Cancer Research Award 2013
I. Ahmad, Glasgow, United Kingdom
Supported by an unrestricted educational
grant from the FRITZ H. SCHRÖDER
FOUNDATION
- From left to right: I. Ahmad, F.H. Schröder
(FRITZ H. SCHRÖDER FOUNDATION) and
P-A. Abrahamsson
P. Rigatti, Milan, Italy
I. Sinescu, Bucharest, Romania
R. Umbas, Jakarta, Indonesia
Prize for the Best Paper published on Clinical Research in the Urological Literature in 2012
Prize for the Best Paper published on Fundamental
Research in the Urological Literature in 2012
E. Martens, S. Jalava, N. Dits, G. Van Leenders,
S. Møller, J. Trapman, C. Bangma, T. Litman,
T. Visakorpi, G. Jenster (Rotterdam, The Netherlands;
Tampere, Finland; Vedbeak, Denmark)
For the paper: “Diagnostic and prognostic signatures
from the small non-coding RNA transcriptome in prostate
cancer.”
Oncogene 2012;31:978-991. – doi: 10.1038/onc.2011.304
Prize for the Best Scientific Paper published in European Urology in 2012
R. Rosenblatt, A. Sherif, E. Rintala, R. Wahlqvist, A. Ullén,
S. Nilsson, P-U. Malmström, The Nordic Urothelial Cancer
Group (Katrineholm, Stockholm, Uppsala, Sweden; Helsinki,
Finland; Oslo, Norway)
For the paper: “Pathologic downstaging is a surrogate marker
for efficacy and increased survival following neoadjuvant
chemotherapy and radical cystectomy for muscle-invasive
urothelial bladder cancer.”
European Urology 2012;61(6):1229-1238.
Supported by an unrestricted educational grant from ELSEVIER
- From left to right: A. Sherif who accepted the award on
behalf of R. Rosenblatt, F. Montorsi and J. Catto
S. Shariat, M. Rink, B. Ehdaie, E. Xylinas, M. Babjuk, A. Merseburger,
R. Svatek, E. Cha, S. Tagawa, H. Fajkovic, G. Novara, P. Karakiewicz,
Q-D. Trinh, S. Daneshmand, Y. Lotan, W. Kassouf, H-M. Fritsche,
F. Chun, G. Sonpavde, A. Joual, D. Scherr, M. Gonen (New York,
San Antonio, Los Angeles, Dallas, Houston, United States of America;
Hamburg, Hanover, Regensburg, Germany; Paris, France; Prague,
Czech Republic; Padua, Italy; Montreal, Canada; Casablanca, Morocco)
For the paper: “Pathologic nodal staging score for bladder cancer:
A decision tool for adjuvant therapy after radical cystectomy.”
Eur Urol 2013 Feb;63(2):371-8. doi: 10.1016/j.eururo.2012.06.008.
Epub 2012 Jun 16.
Prize for the Best Scientific Paper published on Fundamental Research in
European Urology by a young urologist in 2012
R. Kandimalla, A. Van Tilborg, L. Kompier, D. Stumpel, R. Stam,
C. Bangma, E. Zwarthoff (Rotterdam, The Netherlands)
For the paper: “Genome-wide analysis of CpG island methylation
in bladder cancer identified TBX2, TBX3, GATA2, and ZIC4 as
pTa-specific prognostic markers.”
Supported by an unrestricted educational grant from ELSEVIER
- From left to right: E. Zwarthoff who accepted the award on
behalf of R. Kandimalla, F. Montorsi and J. Catto
Award Gallery
Friday, 15 March
Prize for the Best Scientific Paper published on Clinical Research in
European Urology by a young urologist in 2012
M. Rink, B. Ehdaie, E. Cha, D. Green, P. Karakiewicz, M. Babjuk, V. Margulis,
J. Raman, R. Svatek, H. Fajkovic, R. Lee, G. Novara, J. Hansen, S. Daneshmand,
Y. Lotan, W. Kassouf, H-M. Fritsche, A. Pycha, M. Fisch, D. Scherr, S. Shariat
(New York, Dallas, Hershey, San Antonio, Los Angeles, Houston, United States of
America; Hamburg, Regensburg, Germany; Montreal, Canada; Prague, Czech
Republic; St. Poelten, Austria; Padua, Bolzano, Italy) Bladder Cancer Research
Consortium (BCRC) and Upper Tract Urothelial Carcinoma Collaboration (UTUCC)
For the paper: “Stage-specific impact of tumor location on oncologic outcomes in
patients with upper and lower tract urothelial carcinoma following radical surgery.”
- From left to right: M. Rink, F. Montorsi and J. Catto
The European Urology Platinum Award 2013
From left to right: W. Artibani,
C. Pierce, H. Van Poppel,
C. Schulman, J. Roelofswaard,
P-A. Abrahamsson, M. Wirth,
M. Schlief, F. Montorsi and
J. Catto
March/May 2013
5
Overview of prizes and awards at the 28th Annual
First Prize for the Best Abstract (Oncology)
J. Moll, R. Van Soest, J. Kumagai, R. Graeser, I. Hickson,
G. Jenster, W. Van Weerden
(Rotterdam, The Netherlands; Beerse, Belgium)
For the abstract: “824 Abiraterone is able to block AR
activation induced by accumulating levels of precursor
hormones resulting from CYP17A1 inhibition.”
- Handed out by A. Stenzl
First Prize for the Best Abstract (Non-Oncology)
M. Lanz, C. Birchall, A. Ali, K. Walton,
C. Townes, L. Lim, S. Roushias, P. Aldridge,
R. Pickard, J. Hall (Newcastle Upon Tyne,
United Kingdom)
For the abstract: “623 Bacterial motility and
NF-kB activation by clinical isolates from urinary
tract infections.”
Second Prize for the Best Abstract (Oncology)
Award
Gallery
P. Sooriakumaran, L. Haendler, T. Nyberg, I. Heus,
M. Olsson, S. Carlsson, M. Roobol, P. Wiklund
(Stockholm, Sweden; Rotterdam, The Netherlands)
For the abstract: “912 Comparative oncologic
effectiveness of radical prostatectomy and radiotherapy
in prostate cancer: An analysis of mortality outcomes in
34,515 patients treated with up to 15 years follow-up.”
Friday,
15 March
Second Prize for the Best Abstract (Non-Oncology)
K. Filipski, K. Deckmann, T. Bschleipfer,
G. Krasteva-Christ, T. Papadakis, A. Rafiq,
M. Wolff, I. Ibanez-Tallon, B. Schütz,
E. Weihe, W. Kummer
(Giessen, Berlin, Marburg, Germany)
For the abstract: “62 A new cell in the
urogenital tract - cholinergic chemosensory
brush cells are sentinels of the urethra.”
Third Prize for the Best Abstract (Oncology)
H. Uemura, T. Kimura, K. Yoshimura, T. Minami,
M. Nozawa, T. Nakagawa, H. Fujimoto, S. Egawa,
A. Yamada, K. Itoh (Osaka, Tokyo, Fukuoka, Japan)
For the abstract: “98 Combination therapy of peptide
vaccines and dexamethasone for hemotherapy naïve
castration resistant prostate cancer - a randomized
phase-2 study.”
Third Prize for the Best Abstract (Non-Oncology)
Y. Song, H. Lee, J. An, J. Yun, J. Kim, S. Doo,
W. Yang, S. Kim (Seoul, South Korea)
For the abstract: “325 Repair of erectile dysfunction
using transplantation of human mesenchymal stem
cells cultivated on the surface of nanofibrous meshes
in rats with cavernous nerve injury.”
- Handed out by A. Stenzl to J. Yun who accepted
the award on behalf of Y. Song
First Video Prize
Video
Award
Session
O. Ukimura, A. De Castro Abreu, M. Nakamoto, S. Shoji, S. Leslie,
A. Berger, A. Goh, M. Desai, M. Aron, I. Gill (Los Angeles, United
States of America)
For the video: “V79 Novel surgical tile-pro navigation with 3D
prostate cancer model during robot-assisted radical prostatectomy.”
- From left to right: P.A. Geavlete, O. Ukimura and A. Messas
Monday,
18 March
Second Video Prize
Third Video Prize
A. Rao, R. Gray, H. Motiwala, M. Laniado, O. Karim (Wexham,
United Kingdom)
For the video: “V78 Sequential occlusion angiography using
contrast enhanced ultrasound scan (CEUS) demonstrating the
avascular plane of Brodel: An adjunct to a novel technique of
zero-ischaemia robot-assisted partial nephrectomy.”
- From left to right: P.A. Geavlete, O. Karim, who accepted the
award on behalf of A. Rao, and A. Messas
Section
Awards
Saturday,
16 March
S. Crouzet, Lyon, France
For the video: “V77 Alternative solution to current MIS
robotic system.”
- From left to right: P.A. Geavlete, S. Crouzet and
A. Messas
Best Booth Award 2013
Millennium: The TAKEDA Oncology Company
- From left to right: P-A. Abrahamsson,
V. Kemp, C. Kruhl, J. Vachon, R. Cacioppo and
L. Khoury (Millennium: The TAKEDA Oncology
Company)
ESUI Vision Award 2013
F.E. Lecouvet, Brussels, Belgium
For the paper: “Can whole-body magnetic resonance imaging with
diffusion-weighted imaging replace Tc 99m bone scanning and
computed tomography for single-step detection of metastases in
patients with high-risk prostate cancer.”
Supported by an unrestricted educational grant from HITACHI
MEDICAL SYSTEMS EUROPE / HITACHI ALOKA MEDICAL
- From left to right: J. Walz, B. Dowell (HITACHI MEDICAL SYSTEMS
EUROPE / HITACHI ALOKA MEDICAL) and F.E. Lecouvet
6
March/May 2013
EAU Congress
ESRU Campbell’s Challenge
First Prize for the Best Abstract by a resident
The winner of the Campbell’s
Challenge is J. Roth, Klagenfurt,
Austria
- Handed out by T. Esen
Residents
Day
Saturday,
16 March
Second Prize for the Best Abstract by a resident
F. Castiglione, P. Hedlund, F. Van Der Aa,
T. Bivalacqua, M. Albersen (Milan, Italy; Leuven,
Belgium; Baltimore, United States of America)
For the paper: “324 Intratunical injection of
human adipose tissue-derived stem cells prevents
fibrosis and is associated with improved erectile
function in a rat model of Peyronie’s disease.”
- From left to right: F. Castiglione, M. Albersen
and T. Esen
G. Shaw, D. Lewis, J. Boren,
A. Ramos-Montoya, D. Soloviev,
R. Bielik, K. Brindle, D. Neal
(Cambridge, United Kingdom)
For the paper: “833 Monitoring the
effects of therapeutic fatty acid
synthase inhibition in prostate cancer
using 11C acetate PET.”
- Handed out by T. Esen
Third Prize for the Best Abstract by a resident
A. Ingels, A. Thong, M. Saar, M. Valta, R. Nolley,
J. Santos, H. Zhao, D. Peehl (Stanford,
United States of America)
For the paper: “975 Pre-clinical trial of a new dual
mTOR inhibitor: INK128 for renal cell carcinoma.”
- A. Ingels
Resident’s Corner Awards - Awards for the two Best Scientific Papers published in European Urology by a resident in the year 2012
T. Hambrock, C. Hoeks, C. Hulsbergen-Van De Kaa,
T. Scheenen, J. Fütterer, S. Bouwense, I. Van Oort,
F. Schröder, H. Huisman, J. Barentsz (Nijmegen,
Rotterdam, The Netherlands)
For the paper: “Prospective assessment of prostate cancer
aggressiveness using 3-T diffusion-weighted magnetic
resonance imaging–guided biopsies versus a systematic
10-core transrectal ultrasound prostate biopsy cohort”
European Urology;61(1):177-184.
- From left to right: F. Montorsi, I. Van Oort who accepted the award on behalf of T. Hambrock, T. Esen and J. Catto
E. Cha, L-A. Tirsar, C. Schwentner, P. Christos,
C. Mian, J. Hennenlotter, T. Martini, A. Stenzl,
A. Pycha, S. Shariat, B. Schmitz-Dräger
(New York, United States of America;
Nürnberg, Tübingen, Germany; Bolzano, Italy)
For the paper: “Immunocytology is a strong
predictor of bladder cancer presence in patients
with painless hematuria: a multicentre study.”
- From left to right: F. Montorsi, E. Cha, T. Esen and J. Catto
EUSP Best Scholar Award 2013
EUSP
Session
L.F. Arenas Da Silva, Mullheim an der Ruhr,
Germany
For his report: “Urethral Reconstruction using
tissue engineering techniques.”
- From left to right: P. Mulders, V. Mirone,
L. Arenas Da Silva, L. Martínez Piñeiro
First Prize for the Best EAUN Poster Presentation
B. Bonfils, M. Højgaard, J. Meinung, M. Kelsen,
G. Lam Wrist (Herlev, Denmark)
For the poster: “Patient comfort during intravesical
chemotherapy - a randomized trial comparing two
methods of instillation.”
- Handed out by K. Fitzpatrick
Monday,
18 March
Second Prize for the Best EAUN Poster Presentation
N. Raue, C. Hitschler, B. Domurath
(Bad Wildungen, Germany)
For the poster: “Importance of ultrasound
determination of the urinary bladder volume for
care in patients with spinal cord injury (SCI) who
practise catheterization.”
Second Prize for the Best EAUN Poster Presentation
A. Ungricht, M. Widmer, T. Makris, N. Schölly, M. Walter, T.M. Kessler
(Zurich, Switzerland)
For the poster: “Urodynamics in spinal cord injury patients: Be aware of
autonomic dysreflexia.”
Prize for the Best EAUN Nursing Research Project
EAUN
Meeting
Monday,
18 March
E. Grainger, R. Knudsen, L. Aarvig, B. Thoft Jensen (Århus, Denmark)
For the Project Plan: “Optimizing the implementation of fast-track
nephrectomy pathways.”
March/May 2013
7
• What project are you working on now?
Staying alive as long as possible to defeat the insurance company
(laughs). Seriously, I finished (in 2012) writing a paper for the British
Medical Journal about medicine and bureaucracy, and the impact
on medical decisions.
• What’s the first operation you ever did?
Appendectomy- as a student. The first thing that strikes you is when
you make the first incision and the amount of pressure you make. I
fiddled around and just made a little scratch.
• If you were not a urologist, what would you be?
I would still be a surgeon. I would hate sitting in an office looking
at the computer or fiddling with paper.
• What’s the last great book you have read?
The Letters of P.G. Wodehouse. Quite fun, that would entertain you.
• What’s the last thing that surprised you?
To reach this age when nothing surprises you. In general, anything
a politician would do now would not surprise me.
• Do you collect anything?
I collect and restore old cars. It takes up a lot of space. Luckily I got
a bit of land. The oldest one is a 1954 Morris Minor. The most recent
is a Lotus 1981. The great excitement of driving an old car is that you
never know what’s going to break down.
• What’s your favorite hour in a day and why?
When I go to bed and read.
• What would you be doing in your free time?
I’m being run by my wife (laughs hard).
• What question you haven’t found an answer yet?
Oh, good lord… It boils down to small particle physics, what is
controlling all these. I don’t have any particular religious beliefs but
I’d like to know where it’s all going to go.
• What is your biggest fear?
TEN QUESTIONS
Interview by Joel Vega
(Long pause) Having a heart attack, probably that’s my biggest fear.
Age: 85
Specialty: Urology
City/Neighbourhood: Dorking, south London,
United Kingdom
Recent Awards: EAU Innovators in Urology Award 2012
JOHN WICKHAM
London hosts 3rd ESGURS-ESAU
Experts to tackle challenges with insightful strategies
http://esgurs-esau.uroweb.org
With the goal to closely examine challenging issues in
reconstructive urology and andrology, and provide
practical approaches to many problematic cases, the
EAU Section of Genito-Urinary Reconstructive
Surgeons (ESGURS) and the EAU Section of
Andrological Urology (ESAU) will hold its 3rd Joint
ESGURS-ESAU meeting in London in September.
3rd Joint Meeting of the
EAU Section of GenitoUrinary Reconstructive
Surgeons (ESGURS) and the
EAU Section of Andrological
Urology (ESAU)
The ESGURS sessions on the first day will also feature
live surgeries on slings versus sphincter for
incontinence cases, to be followed by a series of
lectures and video presentations that will closely look
into pelvic fracture urethral reconstruction, renal
trauma management, iatrogenic ureteric trauma
management and treatment approaches of degloving
genital injury.
The two-day meeting from September 13 to 14 will
present live surgeries by many of Europe’s leading
reconstructive and andrological specialists,
instructive lectures and video presentations and a
series of debates that will examine key issues in both
fields.
The ESAU session, on the other hand, will focus on
managing infertility which will cover topics such as
ejaculatory disturbances and duct obstruction,
vasovasostomy, varicocele therapy, sperm retrieval
and epididymovasostomy.
“The use of minimal invasive techniques, which are
currently used in the field of reconstructive urology,
will be featured and how it impact on treatment
outcomes. Update lectures, video presentations to
show the latest techniques and live surgery to be
performed by the leading experts will also be held,”
according to the organisers.
The second and last day will open with live surgeries
on penile and urethral reconstruction for lichen
sclerosus (BXO), and a follow-up surgical session on
penile implants. Two blocks of debates will be
featured by both the ESGURS and the ESAU, with the
aim to highlight practical issues and clarify key points
in much-debated controversies.
The live surgery sessions, which will be conducted in
accordance with the recently issued EAU Guidelines
on ethical live surgeries, will be directly transmitted
from the operating theatres of the UCLH Education
Centre in London to the meeting rooms. Moderated
commentary and interactive audience feedback will
guide the programme to further prompt insightful
discussions.
The ESGURS debates will tackle the following topics:
management of bladder neck contractures after
prostate cancer treatment, with focus on either
reconstruction versus endoscopic procedures; full
length anterior strictures, i.e. interval dilatation versus
reconstruction; among other topics.
Meanwhile, the ESAU debate series will examine a
range of management strategies, such as managing
The organisers, led by Professors Anthony Mundy
chronic scrotal pain, management of priapism with
(UK), Serdar Deger (ESGURS chairman) and Wolfgang focus on shunts as compared with early implants; a
Weidner (ESAU chairman), said the meeting’s third
discussion on prostate cancer topics (penile
edition promises to be one of the most comprehensive rehabilitation post therapy and testosterone and PCa)
joint meetings of both sections.
mechanical therapy for Peyronie’s Disease and
micropenis.
Right on the first day, and following an update lecture
on managing ejaculatory dysfunction, two live
“For this much anticipated event, we look forward to
surgeries are scheduled to demonstrate techniques in an in-depth and insightful meeting that will provide
urethroplasty and another session on grafting
all participants not only with a comprehensive
techniques as compared with Nesbit for Peyronie’s
update, but also a new look or examination of current
Disease.
management strategies. (By Joel Vega)
8
13-14 September 2013, London, United Kingdom
EAU meetings
and courses
are accredited
by the EBU in
compliance with
the UEMS/EACCME
regulations
Call for case reports
and videos
deadline 1 July 2013
European
Association
of Urology
March/May 2013
Sexual Medicine takes a step forward with qualifying exam
Everything you want to know about sex but are afraid to ask your patients
Dr. Dr. Stefan
Buntrock
Chief of Urology
Klinik am Kurpark
Bad Wildungen (DE)
The reason why it is so difficult for both doctors and
patients to talk about intimate topics is simple: it is
taboo. Only a minority of us have been brought up
with a proper education about sex, by our parents or
at school. Medical school did not prepare us how to
talk to patients about sex and neither did we get any
training during residency.
Sexual symptoms are not uncommon problems which
are irrelevant for diagnostic purposes or the successful
treatment of a disease. On the one hand they can
indicate or are linked to serious underlying causes like
cardiovascular disease. As stated by other authors, “A
man with ED and no cardiac symptoms is a cardiac (or
vascular) patient until proven otherwise.”
problem. PDE-5 inhibitors might temporarily restore
erectile function but what if the partner does not
accept them? What if she gets the impression that his
attraction to her is based on a pharmacological
reaction? There is a saying that “talk is cheap”, but
when it comes to sexual medicine, the oral
intervention targeted at the couple is indispensable.
stefan.buntrock@
klinik-am-kurpark.de
So between us and our patients is a sort of tacit
understanding: if you don’t start talking about it, I
certainly won’t. No wonder, a recent survey among
366 general practitioners in northern Germany
revealed that only 19% of the patients have their
sexual history taken routinely1. Conversely, the
incidence and prevalence of sexual health problems is
high.
On the other hand, sexual symptoms can be due to
personal and interpersonal crises, resulting in
significant reductions of individual quality of life.
Sometimes, and particularly in cancer, damage to
one’s sexual function is unavoidable. It is therefore
important to first address sexual issues before
surgical procedures which may have a detrimental
effect on sexual life. But even if the tumour can be
resected, health might be more difficult to restore.
This is because health has something to do with how
we feel about ourselves.
Any physician should be able to take a sexual history,
provide basic information and deal with
misconceptions a couple may have about sex.
Psychosexual treatment methods, on the other hand,
belong in the hands of the specially-trained expert.
December 5, 2012 was a historic date. For the first
time, the Multidisciplinary Joint Committee of Sexual
Medicine (MJCSM) conducted a qualification
examination in the field of sexual medicine.
I was one of the 341 participants from 54 nations who
took the opportunity to become a Fellow of the
European Committee of Sexual Medicine (FECSM). The
examination was intended for physicians who work in
the field. But the more interesting question is: why
should anybody not work in this area of medicine?
Sexual problems result from an abundance of causes
and could be encountered frequently in daily practice if
only doctors would dare to ask. Some basic knowledge
and skills in sexual medicine should therefore be
mandatory for any one practicing medicine.
Nevertheless, many of us feel quite uneasy with the
subject and don’t address it when talking to patients.
“As social beings we need
emotional warmth, acceptance,
the need to feel close to others and
be socially secure. Sexual function
serves this purpose.”
Evidence suggests that roughly one third of the male
and nearly half of the female adult population suffer
from sexual problems.2,3 Less than 25% seek medical
help.4 Urologists are specialists of the genito-urinary
tract, and they should be comfortable in discussing
sexual function in clinical settings.
We all have basic needs that go beyond water, food,
clothing and shelter. As social beings we need
emotional warmth, acceptance, the need to feel close
to others and be socially secure. Sexual function
serves this purpose. It is a multi-layered phenomenon
that involves complex dimensions such as
relationship, lust and reproduction. And besides the
fragile interplay between body and mind, sexual
function usually involves other people which make
things even more complicated.
Unfortunately, we don’t have a pill yet to solve the
Sex has been and will always play a central role in
our lives. But with the complex interplay between
body and mind, sexual dysfunction is common. Thus,
there is a need for more doctors to specialise in this
area, and establishing a qualification examination in
sexual medicine is a major step to a higher level of
medical care.
References
1. Cedzich DA and Bosinski HA. Sexuologie 2010; 17: 135-47.
2. Lewis RW, Fugl-Meyer KS, Bosch R et al. J Sex Med 2004;
1(1): 35-39.
3. Mercer CH, Fenton KA, Johnson AM et al. BMJ 2003; 327:
426-27.
4. Moreira ED, Brock G, Glasser DB et al. Int J Clin Pract
2005; 59: 6-16.
5. Jackson G, Rosen RC, Kloner RA, et al. J Sex Med 2006;
3: 28-36.
Hemorrhagic cystitis: Etiology and treatment
Treatment of hemorrhagic cystitis is difficult with therapies described in literature
Prof. Maurizio Brausi
Chairman of Urology
AUSL Modena
Modena (IT)
[email protected]
Hemorrhagic cystitis is a diffuse inflammatory
condition of the urinary bladder due to an infectious
or noninfectious etiology resulting in bleeding from
the bladder mucosa (definition)1.
Causes
The most common cause of hemorrhagic cystitis is
bacterial infection. Escherichia Coli, Staphylococcus
saprophyticus, Proteus Mirabilis, and Klebsiella are the
most common organisms involved2. Fungal infections
can also cause hemorrhagic cystitis. The most
common organisms are Candida Albicans,
Cryptococccus neoformans, Aspergillus fumigastus and
Torulopsis glabrata. Finally, Schistosoma hematobium
and Echinococcus granulosus may also be implicated.
Nonoxynol-9, ether, allopurinol, methaqualone,
methenamine mandelate, gentian violet and
intravesical instillation of drugs for the treatment of
Non-Muscle Invasive Bladder Cancer (NMIBC) like
Epirubicin, thiotepa, MMC, Gemcitabine and Bacillus
Calmette-Guerin are the most involved agents.
Therapy includes: immediate bladder irrigation.
Oxybutynin, hydrocortisone, dymethyl sulfoxide and
intravesical 50cc of 1% lidocaine with 100 mg of
hydrocortisone for alleviating symptoms6.
“Occupational exposure to chemical
substances, aniline, a costituent
of dyes, and toluidine, found in
pesticides and shoes polish, can
cause hemorrhagic cystitis.”
Chemotherapeutic drugs
Cyclophosphamide and ifosfamide (syntetic
analogues) used in many chemotherapeutic protocols
are the most important agents cuasing hemorrhagic
cystitis. Urinary tract symptoms such as frequency,
urgency, nocturia and dysuria are very common.
Microscopic hematuria occurs in seven to 53% of
patients while gross hematuria in 0.6 to 15%7.
Chronic and recurrent hemorrhagic cystitis often arises Phosphoramide mustard, the active antineoplastic
after radiotherapy and chemotherapy for the treatment metabolite and acrolein are toxic to the urothelium8.
The prolonged exposure of the bladder urothelium to
of pelvic tumours (prostate, bladder, rectal and
gynaecological cancers) and should be considered as
acrolein may determine edema of the bladder
complications of the treatment. Infections are less
mucosa, vascular dilatation and increased capillary
common causes of chronic hemorrhagic cystitis exept
fragility resulting in hemorrage. This complication can
occur in 2 to 40% of patients treated with
in immunocompromised patients.
cyclophosphamide. The onset of hematuria usually
Paediatric and immunocompromised patients are
occurs within 48 hours of treatment9-10.
susceptible to develop viral hemorrhagic cystitis. The
BK polioma virus, adenovirus type 7,11,34 and 35,
Other systemic chemotherapeutic agents: Busulphan
Cytomegalovirus, JC virus and Herpes virus have been (alkyl sulfonate compound used for leukemia) can
implicated3-4. Polyoma virus is the most common
cause hemorrhagic cystitis in 16% of patients, Danazol
cause in a paediatric population and can cause
(semi syntetic anabolic steroid) in 19% of patients
hemorrhagic cystitis in 5.7% to 7.7% bone marrow
with hereditary angioedema. Hematuria occurs after
transplant recipients. The onset is from one to four
a long interval and is related to dose. Tiaprofenic
months after transplantation5.
acid, temozolomide and 9-nitrocamptothecin
(topoisomerase I inhibitor)11. Finally penicillin and its
Systemic diseases
synthetic derivatives like methicillin, carbenicillin,
Hemorrhagic cystitis can occur in patients with
ticarcillin, piperacillin and penicillin G can cause
amyloidosis, rheumatoid artritis and Crohn’s disease. hemorrhagic cystitis through an immunological
mechanism1.
Drugs
Occupational exposure to chemical substances, aniline,
Topical agents can provoke a direct irritation of the
a costituent of dyes, and toluidine, found in pesticides
bladder mucosa.
and shoes polish, can cause hemorrhagic cystitis. Also
chlorodimeform with its metabolite 2-methylaniline
Expert views
(aniline derivative) commonly used on cotton plants
March/May 2013
and fruit trees can cause hemorrhagic cystitis. The
hematuria usually is self-limiting once the exposure to
the agent is eliminated.12
Radiotherapy
Radiation cystitis is a late complication of radiotherapy
for prostate, bladder, rectal and gynaecological cancers
treated conservatively. It occurs at least after 90 days
after the initiation of RT but it may occur also after 10
years of treatment13. The frequency is about 10-20% of
patients treated with external beam radiation develop
bladder-related complications14.
Among the histological features is a progressive
obliterative endoarteritis that leads to ischemia of the
bladder mucosa. Then, the mucosa ulcerates and
bleeds. Neovascularity forms in the damaged areas
causing the typical vascular blush seen at cystoscopy.
The newly-formed vessels are more fragile. In case of
bladder distension of minor trauma or any mucosal
irritation bleeding is possible. Acute episodes usually
stop in 12-18 months in most of these patients14.
Late radiations injuries are irreversible and
progressive. The time interval between the treatment
and development of delayed symtoms is inversely
proportional to the dose received15. The
pathophysiology of late radiation damage includes
cellular depletion, fibrosis and obliterative
endoarteritis16.
The fibrosis decreases the bladder capacity and
patients complain of urgency, frequency and dysuria.
In some cases incontinence may develop1.
Grading of hemorrhagic cystitis
A grading system for severity of hemorrhagic cystitis
has been proposed by Droller17:
0.
1.
2.
3.
4.
No symptoms of bladder irritability or hemorrgae
Microscopic hematuria
Macroscopic hematuria
Macroscopic hematuria with small clots
Massive macroscopic hematuria requiring
instrumentation for clots evacuation and/or
causing urinary obstruction
The most important step in these patients is to
determine the cause of hematuria. If the cause is not
obvious a work-up with urine cytology, upper urinary
tract imaging and cystoscopy should be performed.
The patients medications should be reviewed and
anticoagulants stopped. Laboratory evaluation with
hemoglobin, complete blood count, blood urea, serum
creatinine, coagulation profile and urine culture should
be done1.
Treatment of bacterial, fungal and viral hemorrhagic
cystitis
Bacterial and fungal hemorrhagic cystitis are usually
cured with the appropriate antibiotic and antifungal
therapy according to cultures. In case of viral cystitis,
cidofovir is the drug of choice in immunosupressed
patients1.
Treatment of drug-induced hemorrhagic cystitis
In case of drug-induced cystitis, immediate bladder
irrigation is indicated. Oxybutynin, hydrocortisone,
dymethyl sulfoxide and intravesical 50cc of 1%
lidocaine with 100 mg of hydrocortisone help in
alleviating symptoms5. Drugs should be stopped and in
some cases, when possible, treatments delayed
(chemo therapy or BCG instillation for bladder cancer).
Exposure to chemicals like aniline or other agents
should be eliminated. Usually hematuria is selflimiting in these cases.
Treatment of hemorrhagic cystitis due to
chemotherapeutic agents
Stopping the drug or reducing the dose is the primary
treatment. Hydration and forced diuresis is helpful to
reduce the toxicity profile of the drugs. Continuous
bladder irrigation (CBI) decreases the duration of
exposure of the urothelium to acroelin, reducing
toxicity. The drug sodium 2-mercaptoethane sulfonate
(mesna) iv in three doses can prevent cystitis by
ifosfamide and cyclophosphamide. Mesna is rapidly
excreted by the urinary tract; the sulphydryl group
complexes with the terminal methyl group of acrolein
forming a non toxic thioether7. An initial dose
equivalent to 20% of the ifosfamide dose is given 15
minutes before the drug, followed by the same doses
four and eight hours later.
The role of mesna in preventing hemoragic cystitis
after cyclophosphamide is controversial. Two
randomised controlled studies comparing mesna and
hyperidratation or CBI showed no difference on the
incidence of hematuria18-19. A study comparing
combination of hyperbaric oxygen with mesna showed
93% urothelial protection vs 33% in the non-treated
group. Since cyclophosphamide may produce bladder
cancer (transitional cell carcinoma) in 2 to 5.5 % of
patients7, mesna may reduce the risk20.
Treatment of hemorrhagic cystitis due to radiation
Prevention with accurate tailoring of radiation field
limiting the dose to the bladder is the most important
approach. New technologies like cyberknife can help in
this.
Continued on page 10
9
Continued from page 9
Radiation-induced hemorrhagic cystitis is very difficult
to treat because of the ischemic nature of the disease.
Oral agents like steroids, Vitamin E, trypsin and
orgotein have been used without success1.
the sensory nerves of the bladder. A preliminary
cystoscopy for clots evacuation and fulguration of
bleeding vessels should be perfomed. The skin of the
perineum must be protected with petroleum jelly. A
18F Foley catheter is introduced and 1-2% formalin
under gravity is instilled into the bladder and kept for
15 minutes. About 10-30% of patients may not respond
to low dose and may require a second instillation with
high dose (4-10%)37.
Hyperbaric oxygen (HBO) therapy has been extensively
used and investigated. HBO involves the inhalation of
100% oxygen pressurized to 1.4 -3.0 atm in sessions of
60-120 minutes. These conditions stimulate
angiogenesis, fibroblast proliferation and collagen
“If the cause is not obvious a workformation21. Bevers reported the results of a
up with urine cytology, upper urinary
prospective study on 40 patients treated with 20
sessions of HBO for 90 minutes. The response rate after tract imaging and cystoscopy should
three months was 92.5%, while after 23 months the
be performed.”
recurrence of hematuria was 12% per year22. Chong
23
confirmed these results . The drawbacks of HBO are
risk of tumour growth (enhanced angiogenesis) and
the high costs (10,000-15,000 US dollars per patient)
Embolisation
Super selective embolization with microcatheters of
Hyaluronic acid at a dose of 40 mg/ml solution for 30
vesical arteries has been described by MacIvor et al.
minutes, weekly, used as a preventive measure for
with a success rate of 22-25%. Side effects include
radiation cystitis determines a reduction of baldder
gluteal pain (occlusion of the superior gluteal artery)38.
complications by 33%. Shao et al reported the results
of a study comparing intrvesical hyaluronic acid
Surgery
instillation vs HBO in 36 patients with radiationVarious surgeical procedures have been suggested.
induced hemorrhagic cystitis. No side effects after HA
Placement of bilateral nephrostomy tubes under US
were seen. The improvement rate showed no statistical and occlusion of the ureteral orifices39, urinary
difference between the two groups. Decrease of
diversions, ligation of hypogastric artery and finally
frequency was significant in both groups but persisted cystectomy have been described. Stillwell reported the
in time (12 months) only in HA group. The improvement need of cystectomy in 5% of patients with intractable
in the visual analogic scale remained significant in
hemorrhagic cystitis from cyclophosphamide10.
both groups at 18 months24.
Conclusions
WF-10-the formulation of terachlorodecaoxygen iv, a
Treatment of hemorrhagic cystitis is difficult. A variety
novel healing agent with immune effect (inhibition of
of therapies have been described. However, due to the
chronic inflammatory process) determined a complete rarity of this complication, large studies are lacking.
response rate of 74-88% in patiens with RC from RT for Radiation-induced cystitis is more commonly seen by
cervical cancers25.
urologists because of the extensive use of radiotherapy
for the treatment of locally advanced prostate cancer
Treatment of intractable bladder hemorrhage
and bladder cancer in some countries. HBO seems the
The first step is to insert a three-way catheter to
therapy of choice even if expensive. Surgery should be
decompress the bladder, to evacuate clots and start
considered as the last step for the treatment of this
saline irrigation. In some cases cystoscopic
complication.
examination is needed. The bladder should be
carefully evaluated and every single site of bleeding
References
fulgurate. In patients who do not respond to this
1. Manikandan R, Kumar S, Lalgudi D et al: Hemorragic
treatment further therapies are needed
cystitis: a challenge to the urologist. Indian J Urol
Medical therapies
Conjugated estrogens have been employed for the
treatment of viral and radiation-induced cystitis with
success rates from 60 to 86%26.
Sodium pentosan polysulfates protects the surface of
the bladder mucosa and can reduce the inflammatory
response of the urothelium. One to eight weeks are
needed to reduce the degree of hematuria27.
Instillation therapy
E-aminocaproic acid inhibits fibrinolosis by preventing
the activation of plasminogen to plasmin. It is given
orally, parenterally or intravesically by continuous
bladder irrigation. The maximum recommended
dosage in 24 hour is 30 mg. Sigh et al reported a
response rate of 92% in 37 cases. The major
disadvantage is the clots formation in the bladder.
Patients should be clot-free before treatment.
Alum (aluminium ammonium sulphate or aluminium
potassium sulphate) irrigation causes protein
precipitation, vasoconstriction and decreased capillary
permeability28. The standard dose is 50 mg alum in a
liter of sterile water via CBI 250 ml/h. Complete
resolution of hematuria was achieved in 60-100% of
patients in three to seven days29. Toxicity is minimal. In
children and in patients with renal failure microcytic
anemia, osteomalacia, dementia, encephalopaty,
metabolic acidosis have been described30-31.
Silver nitrate
Instillations cause a chemical coagulation and eschar
at the bleeding sites. It is instilled in the bladder as a
solution at a concentration of 0.5 -1% kept for 10-20
minutes. Reflux should be excluded before instillation
as renal failure due to precipitation and obstruction of
upper tract has been described32.
Prostaglandin E1, E2 and F2 alfa have a cytoprotective
effect by regulating mucus production33. They can also
cause a contraction of the blood vessels in the mucosa
and submucosa via membrane stabilization. Another
action is the determination of platelets aggregation.
Side effects such as bladder spasm has been reported
in 78% of patients34-35.
Formalin (40% formaldehyde) is the most effective
hemostatic agent used intravesically. Formalin
rapidly fixes the bladder mucosa through a process
involving protein cross-linking36. Reflux should be
ruled out before instillation. Formalin must be instilled
under general or spinal anesthesia since it is caustic to
10
Clin Oncol 1991;9:2016-20.
19. Vose JM, Reed EC, et al. Mesna compared with continuous
bladder irrigation as uroprotection during high-dose
chemotherapy and transplantation: A randomized trial. J
Clin Oncol 1993;11:1306-10.
20.Cannon J, Linke CA, et al. Cyclophosphamide associated
carcinoma of urothelium: Modalities for prevention.
Urology 1991;38:413-6.
21. Marx RE, Ehler WJ, et al. Relationship of oxygen dose to
angiogenesis induction in irradiated tissue. Am J Surg
1990;160:519-.
22.Bevers RF, Bakker DJ, et al. Hyperbaric oxygen treatment
for haemorrhagic cystitis. Lancet 1995;346:803-5.
23. Chong KT, Hampson NB, et al. Early hyperbaric oxygen
theraphy improves outcome for radiation induced
haemorrhagic cystitis. Urology 2005;65:649-53.
24.Shao Y. et al. Comparison of intravesical hyaluronic acid
instillation and hyperbaric oxygen in the treatment of
radiation-induced hemorrhagic cystitis. BJUI. Volume 109,
Issue 5, pages 691–694, March 2012
25.Veerasarn V, Boonnuch W, et al. A phase II study to
evaluate WF 10 in patients with late haemorrhagic
radiation cystitis and proctitis. Gynecol Oncol
2006;100:179-84.
26.Heath JA, Mishra S, et al. Estrogen as treatment of
haemorrhagic cystitis in children and adolescents
undergoing bone marrow transplantation. Bone Marrow
Transplant 2006;37:523-6.
27. Hampson S, Woodhouse C. Sodium pentosanpolysulphate
in the management of haemorrhagic cystitis: Experience
with 14 patients. Eur Urol 1994;25:40-2.
28.Arrizabalaga M, Extramiana J, et al. Treatment of massive
hematuria with aluminum salts. Br J Urol 1987;60:223-6.
29.Choong SK, Walkden M, et al. The management of
intractable hematuria. BJU 2000;86:951-9.
30.Perazella M, Brown E. Acute aluminum toxicity and alum
bladder irrigation in patients with renal failure. Am J
Kidney Dis 1993;21:44-6.
31. Bogris SL, Johal NS, et al. Is it safe to use aluminum in the
treatment of pediatric hemorrhagic cystitis? A case
discussion of aluminum intoxication and review of the
literature. J Pediatr Hematol Oncol 2009;31:285-8.
32.Ragavaiah NV, Soloway MS. Anuria following silver nitrate
irrigations for intractable bladder haemorrhage. J Urol
1977;118:681-2.
33. Jeremy JY, Mikhailidis DP, et al. The rat urinary bladder
produces prostacyclin as well as other prostaglandins.
Prostaglandins Leukot Med 1984;16:235-48.
34.Levine LA, Krane DM. Evaluation of carboprost
tromethamine in the treatment of cyclophosphamideinduced haemorrhagic cystitis. Cancer 1990;66:242-5.
35.Laszlo D, Bosi A, et al. Prostaglandin E2 bladder
instillation for the treatment of hemorrhagic cystitis after
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1995;80:421-5.
36.De Vries CR, Freiha FS. Hemorrhagic cystitis: A review. J
Urol 1990;143:1-9.
37. Vicente J, Rios G, et al. Intravesical formalin for the
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38.McIvor J, Williams G, et al. Control of severe haemorrhage
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39.Gonzalez CM, Case JR, et al. Glutaraldehyde cross-linked
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percutaneous nephrostomy: A minimally invasive option
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3. Erard V, Storer B, et al. BK virus infection in
haematopoietic stem cell transplant receipents:
Frequency, risk factors and association with post
engraftment haemorrhagic cystitis. Clin Infect Dis
2004;39:1861-5.
4. Hofland CA, Eron LJ, et al. Haemorrhagic adenovirus
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2004;36:3025-7.
5. Dropulic LK, Jones RJ. Polyomavirus BK infection in blood
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8. Schoenike SE, Dana WJ. Ifosfamide and mesna. Clin
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9. Cox PJ. Cyclophosphamide cystitis. Identification of
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10. Stillwell TJ, Benson RC Jr. Cyclophosphamide- induced
hemorrhagic cystitis. A review of 100 patients. Cancer
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11. Islam R, Issacson BJ, et al. Hemorrhagic cystitis as an
unexpected adverse reaction to temozolomide: Case
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12. Folland DS, Kimbourgh RD, et al. Acute hemorrhagic
cystitis. Industrial exposure to the pesticide
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13. Cox JD, Stetz J, et al. Toxicity criteria of the Radiation
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for Research and Treatment of Cancer (EORTC). Int J Radiat
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14. Corman JM, McClure D, et al. Treatment of radiation
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SEPTEMBER 8–12, 2013
www.siucongress.org
Featuring the ICUD Consultations on
Upper Tract Urothelial Carcinoma
Congenital Anomalies in Children
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Clinical challenge
Prof. Oliver
Hakenberg
Section editor
Rostock (DE)
Case study No. 33
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.
Oliver.Hakenberg@
med.uni-rostock.de
This 64-year-old lady presented with the incidental
finding of presumably neoplastic lesion of the right
kidney (fig. 1). Pre-operative staging, however,
showed pulmonary hilar lesions on the left side (fig.
2) which were considered to be neoplastic as well.
A transbronchial biopsy of the hilar lesion was done
and histology was assessed as being compatible with
renal cell carcinoma.
Readers are encouraged to provide interesting and challenging cases for
discussion at [email protected]
Case study No. 32
This 27-year-old university student was referred to
our department by an office urologist initially with
a testicular tumour in stage III (embryonal
carcinoma). He had been surgically treated by left
radical orchidectomy in December 2011. After
complete staging which showed multiple
pulmonary, large hepatic and retroperitoneal
lymph node disease, he underwent three courses
of PIE chemotherapy (cisplatin, ifosfamide,
etoposide) with full dosage and re-staging after
the second cycle which showed good response in
all sites.
He underwent retroperitoneal lymphadenectomy in
March 2012 with removal of all residual
retroperitoneal disease; the histology of the nodes
removed showed necrosis and a small area of
mature teratoma. At surgery, the hepatic lesions
had also been biopsied showing necrosis (figure 1).
Following this, the patient received two more
courses of PIE chemotherapy. Re-staging showed
shrinkage of all remaining lesions. One of the
larger pulmonary lesions was surgically removed
Fig. 2: CT scan of April
2012 showing the large of
pulmonary lesion which
was surgically removed
Fig. 1: CT scan of March 2012 showing
hepatic metastases
in May 2012 (figure 2) with histology also showing
necrosis only.
The only marker which had been elevated was HCG
which had normalized after the first three courses of
chemotherapy. In October 2012, the office urologist
informed us that the patient was well but the HCG
had increased to 27 U/l (normal range up to 4 U/l).
Re-staging was initiated which showed further
regression of the remaining known lesions. Within
three weeks, however, HCG had increased to 3000 U/l
and the patient was referred to us again. He was
admitted one week later and on admission HCG was
9000 U/L. Another staging including a PET/CT
reported reduction in size of all known lesions, no
new lesions and some new metabolic activity in
projection to the pleura.
Fig. 1: CT scan of the abdomen
Discussion points:
1. Are other diagnostic tests useful?
2. What treatment options are available?
3. What is the prognosis?
Case provided by O. Hakenberg, Dept. of Urology,
Rostock University, Germany.
[email protected]
A chance of cure with removal of all residual masses and chemotherapy
Comments by
Prof. Dr. Walter Albrecht
Mistelbach (AT)
chemotherapy (PEI/VIP or TIP or VeIP) will result in
long-term remission of about 50%.
Initially this young man has been a case of stage III
nonseminomatous germ cell tumour belonging to
the poor prognosis group according to the IGCCCG
staging system. The five-year survival rate is not
more than 50%.
EAU guidelines are recommending four cycles of
PEB chemotherapy (cisplatin, etoposide,
bleomycin) followed by complete resection of all
metastatic sites within four to six weeks as
standard therapy. In case of necrosis and/or
teratoma no further treatment is needed. In case of
relapse, four cycles of cisplatin-combination
Instead of this the patient only received three cycles of
PEI, followed by retroperitoneal lymphadenectomy.
Histological workup showed necrosis and mature
teratoma, as did the biopsies of the liver metastases
and one surgically removed pulmonary lesion.
Obviously, further surgery has been calculated to be
risky; therefore two more cycles of PEI have been
administered showing shrinkage of all remaining
lesions together with normalisation of HCG.
the more myelotoxic regimen? It may be speculated
that bleomycin has been avoided because of an
unreported impairment of lung function. Why was
retroperitoneal lymphadenectomy performed
already after the third instead of the fourth cycle of
chemotherapy leading to a delay of further cycles?
Fig. 2: Pulmonary CT scan
Discussion points:
1. Are other diagnostic tests useful?
2. What treatment options are available?
3. What should be done?
As dramatic increase of HCG has been documented,
it may be recommended to also check the brain
and bones for metastases. As there may be some
vital cancer cells especially in the liver, an attempt
to remove all residual lesions should be made now
followed by second-line chemotherapy.
Case provided by O. Hakenberg, Dept. of Urology,
Rostock University, Germany.
[email protected]
Five months later a dramatic increase of HCG up to
9000 U/l occurred but restaging showed further
reduction of all known lesions.
Nevertheless the five-year survival rate of
approximately 50% may be further compromised
by the probably insufficient preoperative cisplatin
dose and the incomplete resection of all lesions
Some questions arise: why was PEI chosen as a
first-line chemotherapy instead of BEP although being after chemotherapy.
Case Study No. 31 continued
This patient had initially been treated by
PIE chemotherapy in view of a history of
bronchial asthma and because the treating
urologist wanted to avoid bleomycinerelated pulmonary toxicity. Retroperitoneal
lymphadenectomy was performed after
only three cycles of chemotherapy instead
of four. However, all removed and biopsied
lesions showed necrosis with only one
retroperitoneal node also showing a small
amount of mature teratoma. Surgical
removal of all lesions was never an option
as there were too many especially in both
lungs. In view of the fact, that preoperative chemotherapy had been
insufficient it was considered necessary to
add two more cycles of PIE which had
shown efficacy before. Following this, the
patient developed recurrence after six
months.
European Urology Today - Manuscript Submission
European Urology Today, the EAU newsletter is
published five times each year. Its main role is to
function as the European Association of Urology’s
bulletin, as a platform for the EAU to present their
meetings, the various sections and offices, as well
as discuss general issues of interest to their
members. Another important objective is to have a
platform that allows for the inclusion of a range of
scientific papers which are considered of interest
to a large readership.
Editorial Policy
Manuscripts are submitted with the explicit
understanding that the decision to include
material will be made by the Editor-in-Chief in
conjunction with his Section Editors. All authors
have read and approved the manuscript subject
to submission. It is the author’s responsibility to
obtain permission to reproduce any parts of other
publications (i.e., tables, figures). Precise reference
to the original work must be given in the legends.
Statements in articles or opinions expressed by any
contributor in any article are not the responsibility
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The publisher will commit itself to make judicious
use of the article in accordance with the aims and
objectives of the association and make the article
available to medical professionals at no cost.
August/September 2011
March/May 2013
Manuscript Submission
Manuscripts and questions regarding manuscript
submission may be directed to:
European Association of Urology
European Urology Today Editorial Office
P.O. Box 30016
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Telephone: +31 (0)26 389 0680
E-mail: [email protected]
Submission of an article signifies the author’s
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of European Urology Today.
All authors are kindly requested to submit a
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Interesting and challenging cases are published
and discussed in the Clinical Challenge section.
Please submit your case for consideration to the
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first author is a resident in training.
All material is to be submitted for consideration to
the section editor responsible for this section,
Dr. Christian Ruf, [email protected]
Types of Articles
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Original articles may be solicited by the editorial
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General reports and papers on interesting
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count for reports are approximately 900/1,000
words.
Reviews of books, journals and new
media
The patient was then restarted on PIE
chemotherapy as re-staging had shown
further shrinkage of all lesions. This led to
an HCG-response which was, however,
comparatively slow. After two cycles, TIP
chemotherapy was started together with
stem cell harvesting. TIP led to a further
marked reduction of HCG but again the
kinetics were not considered adequate.
Therefore, high-dose chemotherapy was
started which the patient is currently
undergoing.
Books, journals and new media to be considered
for review may be sent to the EUT Editorial Office.
Letters to the editor
Authors are welcome to submit letters to the
editor. The text of letters should be limited to 500
words.
Letters to the editor will be published as space
permits.
Information
All queries on manuscript submission should be
directed to the EUT Editorial Office at
[email protected].
21
11
Key articles from international medical journals
Prof. Oliver Reich
Section editor
Munich (DE)
quartile compared with 2,000 cases prevented by a
similar effort in the lowest PRS quartile (Padditive = 1
× 10-4). Thus, the potential impact of eliminating
smoking on the number of bladder cancer cases
prevented is obviously larger for individuals at higher
than at lower genetic risk.
Oliver.Reich@
klinikummuenchen.de
The findings have implications for targeted prevention
strategies should genetic analysis become widely
available and will undoubtedly serve as a basis for
cost-benefit analysis for competing political intentions
regarding health care, tobacco industries and tax
revenues.
Insulin-like growth factor
receptor-binding protein 5
identified as a promising
marker in urothelial carcinoma
In an exemplary way the authors of this study
systematically searched for and identified a new
marker for urothelial cancer. They assessed the
published transcriptome of urinary bladder urothelial
cancer and identified insulin-like growth factorbinding protein-5 (IGFBP-5) as the most significantly
up-regulated gene associated with the regulation of
cell growth. IGFBP-5 is one of the binding proteins
that regulate insulin-like growth factors (IGFs).
By immunohistochemistry the IGFBP-5 expression
status and its associations with clinicopathological
features and survival in 340 cases of upper urinary
tract urothelial carcinoma (UUT) and 295 cases of
urothelial bladder cancer (UBC) were evaluated.
Additionally, western blot analysis was performed to
evaluate IGFBP-5 protein expression in human
urothelial cell lines.
IGFBP-5 overexpression was significantly associated
with advanced pT stage (p < 0.001), higher
histological grade (UUT, p < 0.001; UBC, p = 0.035),
lymph node metastasis (UUT, p = 0.006; UBC, p =
0.004), vascular invasion (UUT, p < 0.001; UBC, p =
0.003), perineural invasion (UUT, p = 0.034; UBC, p =
0.021) and frequent mitosis (UUT, p < 0.001; UBC, p =
0.023). IGFBP-5 overexpression independently
predicted poor disease-specific survival and
metastasis-free survival in both groups of patients.
Western blot analysis showed IGFBP-5 protein
overexpressed in human urothelial cancer cell lines.
The authors demonstrated convincingly that IGFBP-5
plays an important role in tumour progression in
urothelial carcinoma and that its overexpression is
associated with advanced tumour stage and signifies
poorer clinical outcome.
Source: IGFBP-5 overexpression as a poor
prognostic factor in patients with urothelial
carcinomas of upper urinary tracts and urinary
bladder. Liang PI, Wang YH, Wu TF, Wu WR,
Liao AC, Shen KH, Hsing CH, Shiue YL, Huang
HY, Hsu HP, Chen LT, Lin CY, Tai C, Wu JY, Li CF.
Cancer Res. 2013 Mar 27. [Epub ahead of print]
Cigarette smoking and
genetic susceptibility: 6.2%
life-time risk
The main environmental risk factor for bladder cancer
today is cigarette smoking; however, genetic
susceptibility is of great importance. This paper gives
a detailed analysis of the risk of developing bladder
cancer in a smoking population. The analyses
included up to 3,942 cases and 5,680 controls of
European background in seven studies.
The authors tested for multiplicative and additive
interactions between smoking and 12 susceptibility
loci, individually and combined as a polygenic risk
score (PRS). Thirty-year absolute risks and risk
differences by levels of the PRS were estimated for
U.S. males aged 50 years. Six of 12 variants showed
significant additive gene-environment interactions,
most notably NAT2 (p = 7 × 10-4) and UGT1A6 (p = 8 ×
10-4).
The 30-year absolute risk of bladder cancer in U.S.
males was 6.2% for all current smokers (range 2.9%
to 9.9%). Risk difference estimates indicated that
8,200 cases would be prevented if elimination of
smoking occurred in 100,000 men in the upper PRS
Key articles
12
death donors older than 60 years compared with
brain-death donors of the same age group.
Prolonged cold ischaemic time (> 24 hrs. vs. < 12 hrs.)
was not associated with decreased graft survival for
all decreased-donor kidneys, but was associated with
poorer graft survival for kidneys from circulatorydeath donors than for those from brain-death donors
(HR 2.36, [CI 1.39-4.02, p = 0.004]).
This study shows that there is no difference in the
effect of donor age between kidneys from circulatorydeath and brain-death donors and this will help
reassure clinicians when considering potential kidneys
Source: Common Genetic Polymorphisms Modify offered for transplantation. However, the finding that
increasing cold storage times is associated with
the Effect of Smoking on Absolute Risk of
inferior transplant outcomes for kidneys from
Bladder Cancer. Garcia-Closas M, Rothman N,
Figueroa JD, Prokunina-Olsson L, Han SS, Baris circulatory death donors will need to inform the future
development of the UK national allocation policy.
D, Jacobs EJ, Malats N, De Vivo I, Albanes D,
Purdue MP, Sharma S, Fu YP, Kogevinas M,
Wang Z, Tang W, Tardón A, Serra C, Carrato A,
García-Closas R, Lloreta J, Johnson A, Schwenn
M, Karagas MR, Schned A, Andriole G Jr, Grubb
R 3rd, Black A, Gapstur SM, Thun M, Diver WR,
Weinstein SJ, Virtamo J, Hunter DJ, Caporaso N,
Landi MT, Hutchinson A, Burdett L, Jacobs KB,
Yeager M, Fraumeni JF Jr, Chanock SJ, Silverman
DT, Chatterjee N.
Cancer Res; 73(7); 1-10, 2012
Circulatory-death donor
kidneys don’t tolerate the cold
Transplantation is the preferred treatment for
end-stage kidney disease but there is a severe
shortage of decreased-donor kidneys. In the UK, this
has led to an increasing use of kidneys from
circulatory-death donors. Unlike those donated after
brain death these incur substantial warm ischemic
injury before and during procurement, which results
in poor function immediately after transplantation.
However, emerging evidence shows they provide
satisfactory graft function at least in the medium term
(five years).
Source: Effect of donor age and cold storage
time on outcome in recipients of kidneys
donated after circulatory death in the UK: a
cohort study. Summers DM, Johnson RJ, Hudson
A, Collett D, Watson CJ, Bradley JA.
Lancet 2013; 381: 727-34.
SEER analysis shows no
progress in bladder cancer
survival since 1973
The purpose of the analysis was to examine the
overall and stage-specific age-adjusted incidence,
five-year survival and mortality rates of bladder
cancer in the United States, between 1973 and 2009.
For this end, a total of 148,315 bladder cancer patients
were identified in the Surveillance, Epidemiology and
End Results database (SEER) between years 1973 and
2009. Incidence, mortality, and five-year cancerspecific survival rates were calculated.
Temporal trends were quantified using the estimated
annual percentage change (EAPC) and linear
regression models. All analyses were stratified
according to disease stage and further examined
according to sex, race, and age groups. For results,
the authors report an increase in the incidence rate of
bladder cancer from 21.0 to 25.5/100,000 personyears between 1973 and 2009.
This has led to greater acceptance at least when
donors are less than 60 years. It is therefore of
increasing importance to understand if kidneys from
circulatory-death donors aged older than 60 years
fare any worse than kidneys from brain-death donors.
In addition, as kidneys are allocated on a national
Stage-specific analyses revealed an increase incidence
basis, it is important to understand any extra risks this for localised stage from 15.4 to 20.2 (EAPC: +0.5%, p
poses kidneys from circulatory-death donors.
< 0.001) and distant stage from 0.5 to 0.8 (EAPC:
+0.7%, p = 0.001). During the period examined,
This paper, using data from the UK transplant registry, stage-specific five-year survival rates increased for all
includes all adult recipients of deceased-donor renal
stages, except for that of distant (metastatic) disease.
transplants between 1.1.05 and 1.11.10. Recipients
No significant changes in mortality were recorded
were excluded from the main analysis if they had
among localised (EAPC: _0.2%, p = 0.1) and regional
received a previous renal transplant. All-cause graft
stage (EAPC: _0.1%, p = 0.5).
failure was taken as time from transplantation to graft
nephrectomy or return to dialysis, or death of the
An increase in mortality rates was observed among
patient with a functioning graft. Delayed graft function distant stage (EAPC: +1.0%, p = 0.005). Significant
was defined as the need for dialysis within the first
variations in incidence and mortality were recorded
seven days after transplantation. Graft function was
when estimates were stratified according to sex, race,
measured from the estimated glomerular filtration
and age groups.
rate (eGFR).
Overall, statistically significant changes were
observed, although all were minor. The authors noted
This study shows that there is no
that little or no change in bladder cancer outcomes
difference in the effect of donor age has been achieved during the period studied.
between kidneys from circulatorydeath and brain-death donors…
6490 decreased-donor kidney transplants were done
at 23 centres. Primary non-function was higher in
recipients of kidneys from circulatory-death donors
than in recipients of kidney from brain death donors
(4% vs. 3% p = 0.04) as was delayed graft function
(49% vs. 24% [HR 3.08, p < 0.0001]). Three-year graft
survival showed no difference between circulatorydeath (n = 1768) and brain-death (n = 4127) groups
(HR 1.14, [CI 0.95-1.36, p = 0.16]). Graft function was
marginally lower at 12 months after transplantation in
recipients of circulatory-death donor kidneys
compared with recipients of brain-death donor
kidneys (eGFR 48 ml/min per 1.73 m2 vs. 50 ml/min
per 1.73 m2 p = 0.01). Donor age older than 60 years
(compared with < 40 years) was associated with an
increased risk of graft loss for all decreased-donor
kidneys (HR 2.35, [CI 1.85-3.00, p < 0.001]) but there
was no increased risk of graft loss for circulatory-
Source: Incidence, survival and mortality rates
of stage-specific bladder cancer in United
States: A trend analysis. Firas Abdollah, Giorgio
Gandaglia, Rodolphe Thuret, Jan Schmitges, Zhe
Tian, Claudio Jeldres, Niccolo Maria Passoni,
Alberto Briganti, Shahrokh F. Shariat, Paul
Perrotte, Francesco Montorsi, Pierre I.
Karakiewicz, Maxine Sun.
mortality (CSM) rate and other-cause mortality (OCM)
rate for patients with newly diagnosed bladder
cancer. All patients (n = 3281) identified from a
population-based cancer registry diagnosed between
1994 and 2009 were identified, with a median
follow-up interval of 48 months (IQ range 18.1–98.7).
Competing risk analysis was performed within patient
groups and outcomes compared using Gray’s test.
At five years after diagnosis, 1,246 (40%) patients had
died, (19%) from bladder cancer and 629 (19%) from
other causes. The five-year cancer-specific mortality
rate varied between 1% and 59%, and OCM rate
between 6% and 90% and this depended primarily
on the tumour type and patient age. Cancer-specific
mortality was highest in the oldest patient groups:
few elderly patients received radical treatment for
invasive cancer (52% vs 12% for patients < 60 vs. > 80
years, respectively). Female patients with high-risk
non-muscle-invasive bladder cancer had worse
cancer-specific mortality than equivalent males
(Gray’s p < 0.01) although the rate of BCG usage was
not different.
The authors thus showed that effective treatment is
probably underused in the elderly accounting for their
higher cancer-specific mortality. Also, gender-specific
differences seem to exist certainly in outcomes if not
in management. These data must be taken into
account by clinicians and obviously management
should be adjusted.
Source: Competing mortality in patients
diagnosed with bladder cancer: evidence of
undertreatment in the elderly and female
patients. A P Noon, P C Albertsen, F Thomas, D J
Rosario and J W F Catto.
British Journal of Cancer advance online publication 12
March 2013; doi: 10.1038/bjc.2013.106
Two-weekly versus threeweekly docetaxel to treat
castration-resistant advanced
prostate cancer: a
randomised, phase 3 trial
Docetaxel administered every three weeks is a
standard treatment for castration-resistant advanced
prostate cancer. The authors of this study
hypothesised that two-weekly administration of
docetaxel would be better tolerated than threeweekly docetaxel in patients with castration-resistant
advanced prostate cancer, and initiated a prospective,
multicentre, randomised, phase 3 study to compare
efficacy and safety.
Eligible patients had advanced prostate cancer
(metastasis, a prostate-specific-antigen test result of
more than 10·0 ng/mL, and WHO performance status
score of 0—2), had received no chemotherapy (except
with estramustine), had undergone surgical or
chemical castration, and had been referred to a
treatment centre in Finland, Ireland, or Sweden.
Enrolment and treatment were done between March
1, 2004, and May 31, 2009. Randomisation was done
centrally and stratified by centre and WHO
performance status score of 0—1 vs 2. Patients were
assigned 75 mg/m2 docetaxel intravenously on day 1
of a three-week cycle, or 50 mg/m2 docetaxel
intravenously on days 1 and 15 of a four-week cycle.
10 mg oral prednisolone was administered daily to all
patients. The primary endpoint was time to treatment
failure (TTTF). Data in the per-protocol population
was assessed. The study is registered with
ClinicalTrials.gov, number NCT00255606.
177 patients were randomly assigned to the twoweekly docetaxel group and 184 to the three-weekly
Cancer Epidemiology (2013), http://dx.doi.org/10.1016/j. group. 170 patients in the two-weekly group and 176
in the three-weekly group were included in the
canep.2013.02.002
analysis. The two-weekly administration was
associated with significantly longer TTTF than the
three-weekly administration (5·6 months, 95% CI
Effective treatment for
5·0—6·2 vs 4·9 months, 4·5—5·4; hazard ratio 1·3, 95%
bladder cancer underused in
CI 1·1—1·6, p=0·014). Grade 3—4 adverse events
occurred more frequently in the three-weekly than in
females and in the elderly
the two-weekly administration group, including
neutropenia (93 [53%] vs 61 [36%]), leucopenia (51
[29%] vs 22 [13%]), and febrile neutropenia (25 [14%]
In contrast to a SEER database analysis, this smaller
vs six [4%]). Neutropenic infections were reported
population-based study investigates cancer-specific
and competing mortality risks in bladder cancer. Thus, more frequently in patients who received docetaxel
every three weeks (43 [24%] vs 11 [6%], p=0·002).
the authors determined the bladder cancer-specific
EAU EU-ACME Office
March/May 2013
Prof. Oliver
Hakenberg
Section editor
Rostock (DE)
Oliver.Hakenberg@
med.uni-rostock.de
Women’s Health; ClinicalTrials.gov number,
NCT01166438.
Source: Anticholinergic therapy vs.
OnabotulinumtoxinA for urgency urinary
incontinence. Anthony G. Visco, Linda Brubaker,
Holly E. Richter, Ingrid Nygaard, Marie Fidela R.
Paraiso, Shawn A. Menefee, Joseph Schaffer,
Jerry Lowder, Salil Khandwala, Larry Sirls,
Cathie Spino, Tracy L. Nolen, Dennis Wallace,
and Susan F. Meikle, for the Pelvic Floor
Disorders Network.
N Engl J Med 2012; 367:1803-1813November 8, 2012;
The authors concluded that administration of
DOI: 10.1056/NEJMoa1208872
docetaxel every two weeks seems to be well tolerated
in patients with castration-resistant advanced prostate
cancer and could be a useful option when threeBone density testing among
weekly single-dose administration is unlikely to be
prostate cancer survivorstolerated.
does it happen?
Funding: Sanofi.
Source: Two-weekly versus three-weekly
docetaxel to treat castration-resistant advanced
prostate cancer: a randomised, phase 3 trial.
Pirkko-Liisa Kellokumpu-Lehtinen, Ulrika
Harmenberg, Timo Joensuu, Ray McDermott,
Petteri Hervonen, Claes Ginman, Marjaana
Luukkaa, Paul Nyandoto, Akseli Hemminki, Sten
Nilsson, John McCaffrey, Raija Asola, Taina
Turpeenniemi-Hujanen, Fredrik Laestadius,
Tiina Tasmuth, Katinka Sandberg, Maccon
Keane, Ilari Lehtinen, Tiina Luukkaala, Heikki
Joensuu, for the PROSTY study.
The Lancet Oncology, Volume 14, Issue 2, Pages 117
- 124, February 2013.
doi:10.1016/S1470-2045(12)70537-5
Anticholinergic therapy vs.
OnabotulinumtoxinA for
urgency urinary incontinence
Anticholinergic medications and onabotulinumtoxinA
are used to treat urgency urinary incontinence, but
data directly comparing the two types of therapy are
needed.
Most patients with prostate cancer become long-term
survivors of the disease and so awareness of the late
complications of therapy is important. Androgendeprivation therapy (ADT) is the most frequently used
systemic therapy with up to 50% of men receiving
ADT during the course of their disease. It improves
overall survival when given as an adjuvant therapy for
men with high-risk tumours undergoing radiotherapy
and improves quality of life for men with metastatic
cancer.
Since 2008 guidelines of the National Comprehensive
Cancer Network have recommended routine bone
density testing before and during treatment to
characterise the risk of fracture. In addition, the
American College of Physicians 2008 guidelines
recommend bone density testing among men
receiving treatment with ADT. However, singleinstitution data to date shows low rates of testing.
This paper presents data on bone density testing in a
large population based cohort of older men with
prostate cancer in the USA who received ADT for at
least one year.
March/May 2013
However, a recent modelling study suggested that
bone density testing to guide treatment with
bisphosphonates in men who are receiving ADT for
localised prostate cancer is a cost-effective approach
to this aspect of survivorship care. Thus, as efforts to
improve the delivery of cost-effective preventive care
increase, measuring and incentivising the use of bone
density testing for this population may be an effective
strategy.
Source: Bone density testing among prostate
cancer survivors treated with androgendeprivation therapy. Morgans AK, Smith MR,
O’Malley AJ, Keating NL.
Cancer 2013; 119: 863-70.
Postoperative radiotherapy
after radical prostatectomy
for high-risk prostate cancer
The authors of this EORTC trial report on the
long-term results of immediate postoperative
irradiation versus a wait-and-see policy in patients
with prostate cancer extending beyond the prostate,
aimed to confirm whether previously reported
progression-free survival was sustained.
This randomised, phase 3, controlled trial recruited
patients aged 75 years or younger with untreated
cT0—3 prostate cancer (WHO performance status 0 or
1) from 37 institutions across Europe. Eligible patients
were randomly assigned centrally (1:1) to
postoperative irradiation (60 Gy of conventional
irradiation to the surgical bed for six weeks) or to a
The SEER/Medicare data was used for this analysis.
wait-and-see policy until biochemical progression
136,066 men with local or regional prostate cancer
(increase in prostate-specific antigen >0·2 μg/L
diagnosed from 2001 and 2007 and aged > 66 years at confirmed twice at least two weeks apart). The
diagnosis who were enrolled with Medicare for a year investigators analysed the primary endpoint,
before diagnosis and at least six months after
biochemical progression-free survival, by intention to
diagnosis. Men with metastatic disease were not
treat (two-sided test for difference at α=0.05,
adjusted for one interim analysis) and did exploratory
included as done density scan is unreliable in bone
analyses of heterogeneity of effect. The trial is
with secondary deposits; moreover, guidelines
registered with ClinicalTrials.gov, number
recommend bisphosphonate therapy for metastatic
NCT00002511.
disease.
The authors performed a double-blind, doubleplacebo–controlled, randomised trial involving
women with idiopathic urgency urinary incontinence
who had five or more episodes of urgency urinary
incontinence per three-day period, as recorded in a
diary. For a six-month period, participants were
randomly assigned to daily oral anticholinergic
medication (solifenacin, 5 mg initially, with possible
…a recent modelling study
escalation to 10 mg and, if necessary, subsequent
switch to trospium XR, 60 mg) plus one intradetrusor suggested that bone density
injection of saline or one intradetrusor injection of 100
testing to guide treatment with
U of onabotulinumtoxinA plus daily oral placebo. The
primary outcome was the reduction from baseline in
bisphosphonates in men who are
mean episodes of urgency urinary incontinence per
receiving ADT for localised prostate
day over the six-month period, as recorded in
three-day diaries submitted monthly. Secondary
cancer is a cost-effective approach.
outcomes included complete resolution of urgency
urinary incontinence, quality of life, use of catheters,
and adverse events.
Of these 29,860 men were identified who had
received ADT continuously for at least a year. Receipt
Of 249 women who underwent randomization, 247
of bone density testing was assessed from six months
were treated, and 241 had data available for the
before diagnosis to one year after the initiation of
primary outcome analyses. The mean reduction in
ADT. Demographic data was collected along with data
episodes of urgency urinary incontinence per day over on who was treating the patient in an attempt to
the course of six months, from a baseline average of
identify factors associated with testing.
5.0 per day, was 3.4 in the anticholinergic group and
3.3 in the onabotulinumtoxinA group (P=0.81).
Overall 10.2% of men underwent bone density testing
Complete resolution of urgency urinary incontinence
during the study period. Bone density testing
was reported by 13% and 27% of the women,
increased over time (14.5% of men who initiated ADT
respectively (P=0.003). Quality of life improved in both in 2007-2008 vs. 6% of men who initiated ADT in
2001-2002; odds ratio for 2007-2008 vs. 2001-2002,
groups, without significant between-group
2.29; 95% CI, 1.83-2.85).
differences. The anticholinergic group had a higher
rate of dry mouth (46% vs. 31%, P=0.02) but lower
Men aged over 85 years were less likely to undergo
rates of catheter use at two months (0% vs. 5%,
testing when compared with men less than 70 years
P=0.01) and urinary tract infections (13% vs. 33%,
but there was no difference among the other age
P<0.001).
groups. Black men were less likely than white men to
undergo testing (OR, 0.72; 95% CI, 0.61-0.86), and
The authors concluded that oral anticholinergic
men who were not black or Hispanic had higher rates
therapy and onabotulinumtoxinA by injection were
associated with similar reductions in the frequency of of testing than white men (OR, 1.39; 95% CI, 1.13-1.71).
Men living in areas with higher educational
daily episodes of urgency urinary incontinence. The
group receiving onabotulinumtoxinA was less likely to attainment were more likely to undergo bone density
testing than those living in areas with the lowest
have dry mouth and more likely to have complete
education levels (p < 0.001). Men who visited a
resolution of urgency urinary incontinence but had
higher rates of transient urinary retention and urinary medical oncologist and/or a primary care provider in
addition to a urologist had higher odds of testing than
tract infections.
men who only consulted a urologist (p < 0.001).
Funding: Eunice Kennedy Shriver National Institute of
Evidence about the adverse effects of ADT on
Child Health and Human Development and the
skeletal health has been available for almost a decade
National Institutes of Health Office of Research on
Key articles
but this appears to have little effect on clinical
practice. Perhaps because the data available is based
upon bone mineral density rather than fracture
prevention, and therefore is not believed to be
clinically relevant. It would be interesting to
understand bisphosphonate usage alongside
screening as it is possible men are receiving treatment
without bone density testing.
A total of 1,005 patients were randomly assigned to a
wait-and-see policy (n=503) or postoperative
irradiation (n=502) and were followed up for a
median of 10·6 years (range two months to 16·6
years). Postoperative irradiation significantly
improved biochemical progression-free survival
compared with the wait-and-see policy (198 [39·4%]
of 502 patients in postoperative irradiation group vs
311 [61·8%] of 503 patients in wait-and-see group had
biochemical or clinical progression or died; HR 0·49
[95% CI 0·41—0·59]; p<0·0001). Late adverse effects
(any type of any grade) were more frequent in the
postoperative irradiation group than in the wait-andsee group (10 year cumulative incidence 70·8%
[66·6—75·0] vs 59·7% [55·3—64·1]; p=0.001).
Results at median follow-up of 10·6 years showed
that conventional postoperative irradiation
significantly improves biochemical progression-free
survival and local control compared with a wait-andsee policy, supporting results at five-year follow-up;
however, improvements in clinical progression-free
survival were not maintained. Exploratory analyses
suggest that postoperative irradiation might improve
clinical progression-free survival in patients younger
than 70 years and in those with positive surgical
margins, but could have a detrimental effect in
patients aged 70 years or older.
Funding: Ligue Nationale contre le Cancer (Comité de
l’Isère, Grenoble, France) and the European
Organisation for Research and Treatment of Cancer
(EORTC) Charitable Trust.
Source: Postoperative radiotherapy after radical
prostatectomy for high-risk prostate cancer:
long-term results of a randomised controlled
trial (EORTC trial 22911). Michel Bolla, Hein van
Poppel, Bertrand Tombal, Kris Vekemans, Luigi
Da Pozzo, Theo M de Reijke, Antony Verbaeys,
Jean-François Bosset, Roland van Velthoven,
Marc Colombel, Cees van de Beek, Paul
Verhagen, Alphonsus van den Bergh, Cora
Mr Philip Cornford
Section editor
Liverpool (GB)
Philip.Cornford@
rlbuht.nhs.uk
Sternberg, Thomas Gasser, Geertjan van
Tienhoven, Pierre Scalliet, Karin Haustermans,
Laurence Collette, for the European Organisation
for Research and Treatment of Cancer, Radiation
Oncology and Genito-Urinary Groups.
The Lancet, Volume 380, Issue 9858, Pages 2018 - 2027,
8 December 2012. doi:10.1016/S0140-6736(12)61253-7
PSA testing causes stress
The European Randomized Study of Screening for
Prostate Cancer noted that 75% of men with an
elevated PSA have a negative biopsy. Clearly such
false positive results led to unnecessary invasive
procedures but evidence suggests it also causes
increased utilisation of health care resources and
decreased adherence to further screening.
In women a false positive mammogram has been
shown to be associated with a reduced quality of life
and feelings of anxiety that lasted for at least a year.
In this study qualitative methods were used to obtain
descriptions of the long-term emotional consequences
for men who had an elevated PSA and one or more
negative biopsies.
Data presented was acquired between March 2009
and May 2010 in New Jersey and is a subset (16) of a
larger study (64) looking at men’s decisions regarding
prostate cancer screening. In this group all men had a
positive screening test and one or more negative
biopsies. Interviews were recorded and lasted 30-90
minutes. The interview guide was developed using
Andersen’s Behavior Model of Health service as the
conceptual framework. The data obtained was
analysed by a team containing two family physicians
and two sociologists using iterative cycles of readings
and reflection.
As for most men, elevated PSA led
to a cascade of biopsies and further
PSA tests, as there is no consensus
about how often biopsies should be
repeated.
All subjects not unsurprisingly experienced transient
anxiety while waiting for the results of their prostate
biopsies. This anxiety occurred with every biopsy, not
just the first one. In addition it was possible to identify
three persistent emotional responses. The attitude and
recommendation of the urologist was influential in
how men responded to false positive screening tests.
a)Increased fear of cancer (5) appeared to be
associated with the urologist emphasising the lack
of certainty of a negative biopsy. Indeed one man
was so worried he wanted a prophylactic
prostatectomy. There was also frustration with
uncertainties of PSA screening.
b)Relief with increased vigilance (7). The most
common outcome after a negative biopsy was to
request more frequent screening.
c)Relief with less worry about elevated PSA (4). More
common in men who had had multiple biopsies
and when the urologist reassured men about their
persistently elevated PSA.
This study reported significant emotional
consequences that persisted for up to 24 years after
the initial biopsy. As for most men, elevated PSA led
to a cascade of biopsies and further PSA tests, as
there is no consensus about how often biopsies
should be repeated. This results in increased fear of
cancer or increased vigilance about prostate cancer.
This data suggests we need to develop evidencebased guidelines about further testing after a
negative prostate biopsy.
Source: Emotional consequences of persistently
elevated PSA with negative prostate biopsies.
Scott JG, Shaw EK, Friedman A, Ferrante JM
American Journal of Cancer Prevention 2013; 1: 4-8.
EAU EU-ACME Office
13
EBU Certification Programme
Urology department in Prague receives EBU approval
Prof. Marek Babjuk
Charles University
2nd Medical Faculty
Prague (CS)
Marek.Babjuk@
fnmotol.cz
Prof. Ladislav Jarolim
Charles University
2nd Medical Faculty
Prague (CS)
ladislav.jarolim@
lfmotol.cuni.cz
Founded in 1984, the urological department of the
University Hospital Motol has enjoyed since 1996 the
status of University Clinic at the 2nd Faculty of
Medicine of Charles University in Prague.
With more than 2,400 beds and over 80,000
admissions per year, Hospital Motol is considered the
largest in Czech Republic and one of the biggest in
central Europe. Associate Professor Ivan Kawaciuk led
the department since its establishment until his
retirement in 2009. Kawaciuk is succeeded by the
author, with Prof. Ladislav Jarolim as deputy
chairman. The medical staff is composed of 13
certified urologists, four residents and an internal
medicine specialist. Five junior urologists have
recently passed the European Board of Examinations
and were accorded the FEBU title.
The department has 36 adult patient beds including a
six-bed intensive care unit, four day care beds and
around 3,700 admissions per year. Urology
procedures are performed in two operating rooms.
With full-day surgical services, more than 1,600
patients are treated surgically every year. With our
training goals, our centre focuses on patients for
major urological procedures. For example, every year
50 cystectomies, 160 radical prostatectomies (open or
laparoscopic), more than 120 kidney cancer
procedures (mostly laparoscopic), and 10
retroperitoneal lymph node dissections in testis
cancer, among other procedures, are performed.
At the outpatient department we annually treat 9,000
general urology patients (UTI, LUTS etc.), 9,500
patients with urinary stone disease, 13,000
oncological patients,
2,500 patients with andrological problems and
erectile dysfunction, and 2,000 patients with
functional urology diseases. The outpatient clinic has
facilities to perform intravesical instillation, systemic
chemotherapy, cystoscopies, prostate biopsies or
urodynamics. We also collaborate with other
departments in the hospital such as radiology, clinical
oncology, spinal unit etc.
The department provides a full range urological
practice except for kidney transplantations and ESWL.
Paediatric urology is partially performed in
cooperation with the hospital’s department of
paediatric surgery. Our main focus is on onco-urology.
During the last three years teams were designated for
each onco-urological sub-specialty, each
concentrating on implementing new procedures,
evaluation of results and research activities.
The bladder cancer team conducts research in
non-invasive detection and prognostic factors,
investigates new imaging methods (NBI, PDD) and the
surgical treatment of locally advanced disease. The
renal cancer team addresses new tissue and serum
markers and the improvement of minimally-invasive
treatment modalities. In 2010, the Centre for Research
and Treatment of Prostate Cancer was founded with
broad activities in radical surgery and basic and
clinical research, including defining and using new
prognostic markers and treatment modalities like
immunotherapy.
For potential projects, tissue banking was initiated.
Other activities include reconstructive urology,
surgical operations for incontinence, BPH treatment,
EBU Certified Centres
treatment of urolithiasis
including endoscopic surgery
and metabolic counselling,
treatment of congenital defects
(in cooperation with paediatric
urologists) and andrology.
Another unique activity
includes services and surgical
procedures dealing with
transsexualism. Over 300
operated cases (mostly male to
female) where performed in
the last 12 years.
The chairmen surrounded by the staff of the urological department
The resident training programme was established
based on the requirements of the Czech postgraduate
education system. The teaching programme employs a
systematic training in all urological subtopics, while at
the same time providing an individualised approach in
mentoring residents. In general, training is clinically
oriented. Every resident has a personal written
training programme, which specifies individual
schedule and time periods spent on each subtopic.
Currently, there are four residents in training.
Urology Training in the Czech Republic
• takes five years; this includes four months in
Surgery, two months in Internal medicine, one
month in Gynaecology, two months in Intensive
care and at least one month in Paediatric urology
• During the first year of the training period
residents focus on General urology including
ward rounds of operated patients and
outpatient department.
• After one year residents start to rotate in the
following sub-specialties: Onco-urology,
Reconstructive urology, Female/functional and
Neuro-urology, Paediatric urology, Endoscopy
and laparoscopy, and Andrology.
• During particular sub-specialization courses,
residents assist and perform surgery in the
specific field, study and discuss relevant
literature and clinical papers. Every subspecialization is guided by one or two staff
members, specialized in the relevant topic.
A personal tutor assigned to each resident-in-training
is responsible for fulfilling all points in the teaching
programme. Special attention is paid on the training
of skills in urological interventions and surgery.
Residents maintain an individual logbook with a
given number of performed and assisted operations
and invasive diagnostic procedures.
Residents participate in regular teaching rounds
under the guidance of staff members, regular clinical
conferences, pathology, radiology, oncology and other
multidisciplinary conferences. The level of knowledge
and achieved skills are evaluated every six months by
the personal tutor and yearly by the head of the
department. An important tool is the EBU In-Service
Assessment.
Trainees participate in all available educational
courses and seminars. Presentation skills are trained
during monthly scientific meetings. Each resident is
requested to prepare and present at least one lecture,
every year, on a given topic. From the third residency
year, residents start to present results of their
research activities during the annual meeting of the
national society and, if possible, in international
meetings.
From their second year, residents are included in
research groups and are obliged to write at least two
articles in a peer-reviewed journal during their
training. Due to the success of the training system, the
efficient facilities and the range of academic activities
in clinical work, basic research and publications, the
urology department applied for EBU certification. The
EBU certification, granted for a period of five years in
October 2012, has led to the critical appraisal of our
training programme.
Coimbra’s Residency Training gains EBU certification
A commitment to high quality standards
Dr. Paulo Dinis
Dept of Urology and
Renal Transplantation
University Hospital of
Coimbra
Coimbra (PT)
Portugal is also above the European average in terms
of the number of transplants, with 45.7 renal
transplants/million inhabitant per year.
The University Hospital of Coimbra, an academic
hospital located in Portugal’s central region, serves a
population of over 500,000, and has been building a
respectable reputation in healthcare, education and
research.
[email protected]
Dr. Frederico Furriel
Dept of Urology and
Renal
Transplantation
University Hospital of
Coimbra
Coimbra (PT)
[email protected]
On July 20, 1969 when Neil Armstrong became the
first man to set foot on the moon, history was also
being written in Portugal. On the same day, in
Coimbra, a team lead by Linhares Furtado performed
the first renal transplant in the country despite the
obstacles and the novelty of transplantation
medicine.
Forty years later, the Department of Urology, where
this milestone happened, is now considered as one of
Europe’s leading renal transplantation centres.
EBU Certified Centres
14
The Department of Urology and Renal Transplantation
employs 12 urologists and 10 residents in urology. Its
two in-patient wards have a 53-bed capacity, one for
patients afflicted with various urological diseases,
while the other one is dedicated to renal
transplantation. Besides renal transplantation, the
department is also a centre of expertise in other
urological specialties such as medical and surgical
oncology and laparoscopy. Urological care in all other
areas, such as endourology, andrology, neurourology
and reconstructive urology, is also provided and
maintained with high international standards.
international meetings,
• publish articles
• annually take part in the EBU In-Service
Assessment.
The Portuguese residency training programme
in Urology
• takes six years; including one year in General
Surgery,
• two months in Paediatric Surgery and
• four months in other specialties, such as
Pathology, Radiology, Gynaecology, Vascular
Surgery or Plastic Surgery, depending on the
residents’ choice.
• The programme includes a plan, defining the
knowledge and surgical goals for each year of
the residency.
There are regular multidisciplinary meetings such as
“Morbidity & Mortality” meetings and Campbell
Every year, approximately 2,000 patients are admitted review sessions. Residents keep an updated logbook
to the in-patient facilities, with an estimated 24,000
of their practice and, at the end of each year, all
medical appointments made. The department has two residents write a detailed report on their surgical and
well-equipped surgical theatres, enabling the surgical scientific activities which they also publicly discuss
treatment of over 1,200 patients every year. Outwith the staff.
patient surgery is also preformed once every week.
Many of the facilities required for modern urology
Moreover, during their final residency year residents
practice are available such as urodynamics, flexible
are encouraged to:
cystoscopy ESWL, 3-Tesla MRI, CT, PET-CT scan.
• attend the EUREP (European Urology Residents
Education Programme) course and
At the department, staff and residents are committed • take the written part of the FEBU exam.
to maintain a friendly and cooperative atmosphere,
enhancing intellectual stimulation in both medical
The EBU has granted full certification of the Residency
and surgical training. Residents are encouraged to:
Training Programme for the first time in 2003. The
• take active participation in national and
programme was certified for a second term of five
The staff of the Urology and Renal Transplant Department in
Coimbra
years in October 2012. This is a mark of excellence and
a commitment to maintain high residency training
standards. Furthermore, the application itself
presents a valuable opportunity to gain external
feedback, which is always helpful when continuous
improvement is required.
We are confident that other urology departments in
Portugal will also apply for EBU certification in the
near future, as we are strongly committed to maintain
quality standards in Portuguese urological training
and practice.
Recently, a reform in the healthcare system led to the
merger of our hospital with another tertiary care unit,
creating the largest urology department in the
country. With this recent development we expect
further improvements in patient care, staff training,
and research.
March/May 2013
A chance to join the ...
International Academic Exchange Programme
Chinese Urological Association (CUA) in collaboration with the
European Association of Urology (EAU)
2013 Chinese Tour
The CUA/EAU International Exchange Programme will send Chinese faculty to Europe
and European faculty to China. The programme aims to promote international exchange
of urological medical skills, expertise and knowledge.
To date one Chinese and two European tours have been organised and each of those
proved extremely successful. Therefore the European Association of Urology (EAU) and
the Chinese Urological Association are pleased to announce the 2013 Chinese Tour!
For 2013 the CUA/EAU International Exchange Programme will provide grants to enable
four EAU members (3 junior and 1 senior faculty member) to participate in the Chinese
Tour. The tour should take place from October 1 – 20, 2013 starting with visits to different
urological centres in China, culminating with participation at the CUA Annual Meeting to
be held in Beijing (October 16 – 19, 2013).
Eligibility criteria
• Less than 42 years of age
• Minimum academic rank of assistant professor
• Letter from the departmental chairman of the applicant’s commitment to academic medicine
• Membership of the EAU
• Availability to travel from October 1 - 20, 2013
Information and application forms
For all further information and programme application forms, please visit
www.uroweb.org, and select International Relations, CUA-EAU or contact the EAU Central Office,
T +31 (0)26 389 0680, F +31 (0)26 389 0674, E: [email protected].
EAU Central Office, Attn. Secretariat, P.O. Box 30016, 6803 AA Arnhem, The Netherlands
ERUS 10th Anniversary Meeting
Stockholm to host annual meeting in September
Dr. Magnus
Annerstedt
Herlev Hospital
Dept. of Urology
Herlev (DK)
magnus.annerstedt@
me.com
recent EAU congress in Milan which were wellattended. Our Junior ERUS section also attracts young
urologists interested in robotic urology. They have
their own programme at the annual congress and a
separate working group within the ERUS. We highly
encourage our young colleagues to actively take part
in different working groups to develop the necessary
skills.
The Stockholm meeting will present 10 live surgeries
including standard procedures, prostate, kidney and
bladder, as well as new indications in high-definition
(HD) and 3D by renowned international experts in
robotic surgery. These will be complemented by
The EAU Robotic Urology Section (ERUS), formerly a
non-affiliated society, will hold in Stockholm, Sweden state-of-the-art lectures, workshops and roundtable
the 10th anniversary of its yearly congress. It all
discussions on the latest developments.
started back in 2004 in Paris with about 50
participants, and since then the ERUS Congress has
The venue will be in central Stockholm at the
Stockholm Waterfront Congress Centre, which is
grown steadily with last year’s meeting in Paris
attracting over 700 participants. For the second time located near the city’s major attractions. With its
stunning architecture, meeting participants will not
in its history, Stockholm will host the ERUS meeting
on September 3 to 5, 2013.
only benefit from this very exciting meeting but will
also have the opportunity to explore Stockholm at the
best time of the year in early September.
With its ambitious plans, ERUS aims to be the
scientific platform for every urologist interested in the
ERUS exerts efforts to present high quality robotic
latest development in urological robotic science and
practice with the ultimate goal of improving the level surgery by international experts with interactive
of patient care. Currently, the section has several
moderation to prompt discussions and careful
examination of these procedures. All live surgery will
projects in the pipeline.
comply with the EAU’s new ethical guidelines.
Within the working group of science there are several
New devices from the industry will also be on display
plans such as designing new studies and securing
data collection. A lot of effort is done to achieve and
in the exhibit section. On the opening day, a junior
maintain a high level of surgical science within
ERUS meeting will be held to educate and inspire the
robotic urology, while incorporating traditional open
next generation of minimally invasive surgeons,
followed by courses on individual robotic procedures
surgery as a core expertise or comparison for skills
as well as a separate overview of current robotic
acquisition.
urologic surgery. A day-long course for nurses will
Thus, we are proud to present a robotic master course also be part of the programme to provide tips on
and curriculum to establish and standardise
robotic surgical support and peri-operative patient
care. We look forward to see you in Stockholm!
education and training in an efficient and safe way.
E-learning, master classes and fellowships are all
part of this programme. For instance, we have
Check our website for more details at
www.erus2013.com.
organised hands-on training courses during the
March/May 2013
www.erus2013.com
EAU Robotic
Urology Section
Congress (ERUS’13)
3-5 September 2013, Stockholm, Sweden
EAU meetings
and courses
are accredited
by the EBU in
compliance with
the UEMS/EACCME
regulations
European
Association
of Urology
15
Neobladder and continent cutaneous diversion after RC
An update on continent urinary diversion
Prof. Richard E.
Hautmann
University of Ulm
Ulm (DE)
richard.hautmann@
uni-ulm.de
Prof. Joachim W.
Thüroff
Dept. of Urology
Johannes GutenbergUniversity Mainz
Mainz (DE)
joachim.thueroff@
unimedizin-mainz.de
leakage may occur. A rapid increase in reservoir
capacity following surgery allows daytime continence
to be achieved. Night-time continence is established
less quickly. During sleep, a detrusor-sphincter reflex
normally increases outlet pressure as the bladder wall
stretches during filling; this reflex is lost after
cystectomy. As the reservoir fills at night, additional
outlet contraction is not recruited, and when the rise
in reservoir pressure exceeds outlet pressure,
incontinence occurs.
Men achieve self-assessed continence by day and by
night in 92% and 76% of cases, respectively.
Attempted nerve sparing improves daytime
continence, which worsens with increasing age.3
Urinary tract infection also worsens continence, and
an unexpected deterioration of continence should
prompt exclusion of infection and residual urine or
mucus collection.4 A clinical urinary tract infection is
uncommon.
Upper urinary tract safety: Voiding with a neobladder
cannot produce reflux, which has been confirmed
scintigraphically. Long-term upper tract outcomes are
excellent. As few as 2.7% of patients develop
ureteroileal strictures if a direct end-to-side
anastomosis is used. The use of stents in the
ureteroileal anastomosis improves outcomes.5 Up to
half of patients who develop a short ureteroileal
stricture can be successfully managed
endourologically. The use of an antireflux nipple valve
was associated with a worse outcome than a dynamic
isoperistaltic afferent tubular segment.3
Urinary retention is more common in women
undergoing a neobladder. Such retention may occur
early but often appears after a year or more of good
neobladder function and emptying. In the Ulm series
of 116 women, the rate of retention increased steadily
over time to approximately 50% by five years.3 The
etiology has been debated, but most authors believe
it is due to a kink in the urethra-pouch anastomosis
as the full pouch falls posteriorly during the Valsalva
maneuver.3 This can be documented on a lateral
straining cystogram.
Other suggested etiologies include autonomic
denervation of the urethra or random reinnervation
resulting in an inability to relax the sphincter.3 Since
the first description of this potentially undesirable late
complication, authors have suggested modifications
in surgical technique to try to prevent this problem
and have presented data to suggest improved
outcomes. However, all are consecutive series, and
because the complication may appear late, such
reports may be biased by shorter follow-up in the
“new” group.
unsuitable, a nipple valve is established and fixed to
the ileocecal valve and the reservoir wall with staples.
The serous-lined extramural Valve/T-Pouch: The
principle of the Valve/T-Pouch is the creation of a
serous-lined trough in which a tapered ileal segment
is placed. Two articles described the use of this
technique in Europe. As correctly stated by the
authors of this report, “construction of the pouch is
sophisticated.” This is the main drawback of the
technique and represents a serious obstacle to
general acceptance.3
Stone formation is a common phenomenon after
continent cutaneous reconstruction. Its etiology is
multifactorial including residual urine, chronic
bacteriuria, mucus, and staples.3 Although an
incidence as high as 44% has been reported, most
reports indicate rates of 5-20%.3 The risk of a
perforation/rupture complication is higher after
continent cutaneous diversion than after a neobladder
because the former lacks a pop-off mechanism.8
Other important aspects: Bacterial colonisation after
Nevertheless, some attempts to fill the posterior
continent cutaneous diversion is more prevalent than
pelvis and re-establish anterior and superior fixation after orthotopic reconstruction, but clinically
of the bladder seems to be warranted. Treatment of
symptomatic infections are rare.
retention is intermittent catheterisation. a-Blockers
are not effective. Transurethral resection of a urethral
fold and open reduction of the pouch size with
Summary
anterior fixation to the abdominal wall have also
• Surgical morbidity following continent
been described. Every woman undergoing
urinary diversion is significant and, when
In these patients, the construction of a neobladder
allows the elimination of a stoma and preservation of
neobladder reconstruction should be advised that
strict reporting guidelines are incorporated, it
intermittent catheterisation may be required for
is higher than previously published. Accurate
body image without compromising cancer control.
When involvement of the lower urinary tract by
Postoperative management: Of paramount importance adequate emptying, and she must be willing and able
reporting of postoperative complications after
tumour prohibits the use of a neobladder, a continent is the active postoperative management and regular
to learn how to perform it. Many women who are dry
radical cystectomy is essential for counselling
cutaneous reservoir may still offer some advantages
but require self-catheterisation seem quite satisfied
patients, combined modality treatment
long-term follow-up of patients with a neobladder.
with the diversion.
over an ileal conduit. For patients who are not
The key issues are achieving a capacity of 400-500
planning, clinical trial design, and
assessment of surgical success.
candidates for either type of continent diversion, the
ml, residual-free voiding of sterile urine, and the
Sexual function and quality of life: Only a few studies
ileal loop remains a time honored option.
treatment of any outlet obstruction.3
have examined the postoperative sexual function of
• It is inappropriate to ask for direct
women
undergoing
radical
cystectomy
and
urinary
comparisons of neobladder versus conduit.
Radical cystectomy remains the best treatment option
“Men achieve self-assessed
for patients with invasive bladder cancer. Nevertheless,
diversion. Results suggest that sexual dysfunction is
These are different patient populations, and it
continence by day and by night
is incorrect to assume that patients are
two major problems remain. First: Population-based
common and may be potentially improved by
studies indicate poor utilisation of radical cystectomy
preserving the uterus when possible and preserving
equally suitable for a neobladder and
in
92%
and
76%
of
cases,
the autonomic nerves lateral to the vagina.3
counduit. A prospective randomised trial of a
of less than 40% of patients needing it.1 Second, just
respectively.”
15-20% of radical cystectomy patients received some
neobladder versus conduit is unlikely.
form of continent urinary diversion.2
Continent cutaneous urinary diversion
Minimally invasive surgery: There is increasing interest Numerous techniques of continent cutaneous urinary
• Urinary diversion into bowel segments is not
inherently damaging to the kidneys. However,
Radical cystectomy and urinary diversion are the most in laparoscopic and robotic cystectomy, with either
diversion have been described but some of these
difficult open, laparoscopic, or robotic procedures in
intracorporeal or extracorporeal formation of conduit
appeared only once in the literature, indicating they
any form of obstruction, if left untreated, is
were associated with technical problems, high
detrimental. Infection is also a contributing
urology, more so if the urinary diversion is performed or neobladder.3 Whether reports with intermediate
factor. In general, renal function after
totally intracorporeally. We update the
follow-up suggesting equivalent oncologic outcome
complication rates, and suboptimal functional results.
diversion into continent detubularised
Today, only a handful of methods are in use, and in
recommendations of the ICUD-EAU International
will be confirmed remains to be determined. But
reservoirs is superior to ileal conduit
Consultation on Bladder Cancer/Continent Urinary
there are advantages in terms of blood loss,
general, they are the second choice after neobladder
diversion. However, the literature is
Diversion 2012.3
transfusion rates, postoperative pain, and return of
for patients undergoing radical cystectomy.
insufficient to recommend one form of
bowel function. In most reported series, cases were
diversion over another.
The main indication for continent cutaneous diversion
Male neobladder
highly selected.
is when urethral removal is deemed necessary due to
Age and motivation: There is no age cut-off. Some
• There remains a long-term risk of renal
patients >70 years request the simpler conduit
Female neobladder
a high risk of recurrence of urothelial carcinoma. This
Age alone is not a criterion for offering a neobladder.3 risk can be estimated based on the pathology report
deterioration, which is often asymptomatic,
because the postoperative course is less arduous and
from the preoperative transurethral resection biopsies
and thus close follow-up is necessary for all
incontinence is not an issue. Patient motivation is the
The impact of age on outcomes with a neobladder
patients who have undergone urinary
most important factor when considering the suitability has not been fully determined in women. Women >75 of the prostate. Such biopsies should be taken from
the bladder neck to the verumontanum on both sides
for a neobladder. The extent of pelvic disease has little years of age are at higher risk of incontinence, but
diversion to identify correctable causes early.
bearing on the appropriateness of a neobladder. If
some of them will have excellent neobladder function. before cystectomy. Relying on frozen sections of the
Those with renal pathology prior to surgery
urethra obtained during surgery may be dangerous
seem to be at greatest risk of postoperative
pelvic recurrence develops, it does usually not have a
because of the risk of a false-negative report from the
significant impact on the function of a neobladder.
Patient selection: Prior to the wide adoption of a
renal deterioration. Early intervention for
Although prostatic involvement by urothelial cancer is neobladder for women, it was necessary to show it was pathologist.
physical obstruction often results in a
frequent a neobladder can still be performed if the
safe to preserve the urethra during the cystectomy.3
sustained improvement in renal function.
distal prostatic urethra is cancer-free.3
Only bladder neck involvement and anterior vaginal
Patients who have undergone continent
“It is standard to require a negative
wall invasion predicted urethral involvement, although
cutaneous diversion or a neobladder do not
frozen section of the urethral
Surgical technique: Nerve-sparing cystectomy does not 50% of those with a bladder neck tumour had no
seem to be at increased risk of secondary
just increase the chance of maintaining erectile
tumour in the urethra.3 It is standard to require a
malignancy.
margin prior to proceeding with a
function. In men with a neobladder who had an
negative frozen section of the urethral margin prior to
neobladder in women.3”
attempted nerve-sparing operation, night-time
• Any form of urinary diversion has its specific
proceeding with a neobladder in women.3 Pre existing
continence was better than in those who did not. A
incontinence is a relative contraindication for women
problems. In experienced hands and with
neobladder must be a low-pressure reservoir of
considering a neobladder. A woman with stress urinary Knowledge about the status of the urethra/prostate
regular long-term follow-up, serious
adequate capacity (allowing a socially acceptable
incontinence may be willing to continue to wear pads
enables the surgeon to inform the patient
complications can be avoided and excellent
voiding interval without urinary leakage) and must
rather than deal with a stoma, or she may be
preoperatively definitively about the type of the
long-term results can be achieved. In this
empty to completion. If this is so, the upper tract will
considered for a sling or Burch procedure at the time of diversion to be recommended. Urothelial cell
context, surgeons must continue to refine
be preserved and metabolic disturbance will be
carcinoma located in the urethra or involving the
diversion with planned self-catheterisation.
their surgical technique of radical cystectomy
minimal. Ileum should be used whenever possible.
prostatic ducts or stroma is the main indication for
and urinary diversion to provide the utmost
Detubularisation and a spherical shape ensure that a Anatomic basis of the preservation of continence in
urethrectomy. Some patients may prefer a continent
safety for the patient.3
neobladder has low pressure and maximum volume
women: The neobladder was introduced as an option diversion to a neobladder because of the risk of urine
for the length of bowel used.
for women in the 1990s. Prior to that, it was generally leakage after a neobladder.
• Evidence suggests an association between
believed that the primary continence mechanism in
surgical volume and outcome in radical
Continence is achieved when outlet pressure exceeds
women was located in the bladder neck.3 However, it Antirefluxing ureteric anastomosis is required in
cystectomy; the challenge of optimum care
reservoir pressure. This requires preservation of the
was ultimately recognised that the urethra alone
continent cutaneous diversion because the efficient
for elderly patients with comorbidities is best
sphincter and construction of a low-pressure reservoir could provide continence if the sphincter mechanism
outlet mechanism can allow high intra-reservoir
mastered at high-volume hospitals by
by doubly folding detubularised ileum to achieve the
was preserved.
pressures. Different types of inlet, pouch, and outlet
high-volume surgeons. Preoperative patient
final reservoir volume of 450-500 ml. The reservoir
have been combined. The stoma is usually placed in
information, patient selection, surgical
has initially a volume of around 150 ml. Stretching the Complications: Most of the early and late complications the umbilicus, where it remains invisible.
techniques, and careful postoperative
reservoir is achieved by delaying voiding when the
of women undergoing radical cystectomy and
follow-up are the cornerstones to achieve
patient feels the urge to void is irresistible, and that
neobladder are identical to those of men and are
The ileal nipple valve was used in the first Mainz
good long-term results.3
managed in a similar fashion.3 Two complications are pouch,6 later the submucosally tunnelled
different in women: pouch-vaginal fistula and urinary catheterisable appendix was introduced. Today, the
Expert views
retention.
appendix is the first choice, but if it is missing or
Continued on page 17
Indications and patient selection criteria have
significantly changed over the past two decades. At
high-volume hospitals, orthotopic reconstruction has
become the procedure of choice for urinary diversion
in both men and women undergoing radical
cystectomy.
16
March/May 2013
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Figure 1: Neobladder in a female patient
A Suspensory ligaments, H Urethra, M Neobladder mesentery, R Rectum, S Symphysis pubis, V Vagina.
References
1. Goossens-Laan CA, Visser O, Hulshof MC, et al. Survival
after treatment for carcinoma invading bladder muscle: a
Dutch population-based study on the impact of hospital
volume. BJU Int. 2012;110:226-32.
2. Gore JL, Litwin MS. Urologic Diseases in America Project.
Quality of care in bladder cancer: trends in urinary
diversion following radical cystectomy. World J Urol
2009;27:45-50.
3. Hautmann RE, Abol-Enein H, Davidsson T, Gudjonsson S,
Hautmann SH, Holm HV, Lee ChT, Liedberg F,
Madersbacher S, Manoharan M, Mansson W, Mills RD,
Penson DF, Skinner EC, Stein R, Studer UE, Thueroff JW,
Turner WH, Volkmer BG, Xu A. ICUD-EAU International
Consultation on Bladder Cancer 2012: Urinary Diversion.
Eur Urol 2013;63:67-80.
4. Zehnder P, Dhar N, Thurairaja R, Ochsner K, Studer UE.
Effect of urinary tract infeczion on reservoir function in
patients with ileal bladder substitute. J Urol 2009;181:25459.
5. Studer UE, Burkhard FC, Schumacher M, et al. Twenty
years experience with an ileal orthotopic low pressure
bladder substitute-lessons to be learned. J Urol
2006;176:582-6.
6. Thueroff JW, Alken P, Riedmiller H, Engelmann U, Jacobi
GH, Hohenfelner R. The Mainz pouch (mixed augmentation
ileum and cecum) for bladder augmentation and continent
diversion. J Urol 1986;136:17-26.
7. Thueroff JW, Alken P, riedmiller H, Jacobi GH, Hohenfellner
R. 100 cases of Mainz pouch: continuing experience and
evolution. J Urol 1988;140:283-8.
8. Mansson W, Bakke A, Bergman B, et al. Perforation of
continent urinary reservoirs. Scandinavian experience.
Scand J Urol Nephrol 1997;31:529-32.
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USANZ Trainee Week
Young urologists benefit from comprehensive, quality training
Dr. Martina Wolfgang
General Hospital St.
Pölten
Dept of Urology
St. Pölten (AT)
martina.wolfgang@
stpoelten.lknoe.at
Board of Surgical Education and Training and the
Council of the RACS.
USANZ collaborates with the RACS as an agent of the
College, administers the training programme in
Australia and manages the Board in Urology,
otherwise known as the Training, Accreditation and
Education Committee (TA&E Committee).
Education and training
The SET Programme in urology is designed to improve
the quality and efficiency of surgical education and
From November 18 to 22 last year the annual Trainee training. It starts with two years (SET 1+2) of general
The openness and friendliness of the Australian and New
Week of the Urological Society of Australia & New
Zealand trainees made the international participants feel
surgical skills, followed by three years (SET 3-5) of
Zealand (USANZ) took place in Melbourne and
welcome
advanced clinical urology training and ends with the
Geelong in Victoria, Australia. This programme is a
Senior level, respectively a minimum time of six
component of the SET (Surgical Education and
years.
Training) Programme and is compulsory for all
background including important studies is important
Australian and New Zealand SET (2-5) trainees.
The Trainee Week, which is held in a different
in preparing for the exam, thus most of them are well
Australian state each year or in New Zealand, started prepared.
Approximately 90 trainees from across Australia and
with practice examinations (Practice Vivas and Written
New Zealand and – as part of a reciprocal
Examination). All SET4 trainees undertook the oral
During the next four days an intensive programme is
arrangement with international associations – six
exams and were examined by a SET5 trainee together scheduled with a series of excellently presented
trainees from the European Association of Urology
with a urological consultant. I was fortunate to
lectures, case discussions in small groups, trainee
(EAU), the Urological Association of Asia (UAA), the
observe these exams with the SET3 trainees and the
presentations and a very informative lesson about
British Association of Urological Surgeons (BAUS) and other international registrars.
exam performance from an examiner’s as well as a
the Canadian Urological Association (CUA) attended
psychologist’s point of view.
the meeting.
There are four oral exams; Anatomy and Operative
Surgery, Pathology, Structure Oral and Clinical
I was surprised of the active role the SET4 and
After successfully completing the FEBU Written exam
Investigation and Management. These exams are
especially SET5 trainees had in the programme.
September 2012, I was selected and invited by the
designed to help the trainees prepare for the final
During the lecture series, the trainees also presented
EAU to register for this programme and I felt very
Fellowship Examination. Trainees learn the style of
alternating with urologists, and also led the small
honoured and curious of this unexpected possibility to exam questions and how to think and answer in a
group case discussions and, as previously mentioned,
learn more about the Australian Trainee Programme
structured way. I got the impression that all of the
acted as examiners in the oral exam. For me, it
and also the Australian people and culture.
trainees had a solid basic knowledge of urology,
seemed that most of the trainees know each other,
including anatomy and pathology. Furthermore,
perhaps because of the Trainee Weeks they have
Organisational background
trainees know that knowledge of the scientific
attended before, or due to the fact that all trainees
USANZ, the official and professional body for
have to rotate for their working place/ hospital (and
urological surgeons in Australia and New Zealand, is
in the majority of cases also the town), annually.
committed to clinical excellence, education,
promotion of research and the dissemination of
The Australian and New Zealand SET trainees enjoy a
information on urological topics. On the other hand,
good reputation in international urology and this
the Royal Australasian College of Surgeons (RACS) is
could be attributed to their training as previously
the principal body for the training and education of
described. Changing residence every year impacts
surgeons in both countries. Accreditation is given by
one’s private life and for me, as a European, this is
the Australian Medical Council and the Medical
hard to imagine. But otherwise this system offers the
Council of New Zealand to the RACS which sets the
possibility to a consistent quality in education and
standards for education and training.
training and a fair competition to all trainees.
Furthermore, the trainees learn to accept new
The Board in Urology of the RACS has oversight for
responsibilities and perform with confidence.
An intensive programme is scheduled which includes a series
the conduct of the training programme in urology
across Australia and New Zealand, and reports to the of excellently presented lectures
Compared with Austria, in Australia there seem to be
March/May 2013
no influence of a ‘’settled (or conservative) urology’,
which could explain why there’s a greater focus on
surgical (operative) education during the resident
years. It’s also advantageous that, with the beginning
of the fifth year, the SET trainees are allowed and
encouraged to take their ‘’Final Clinical Examination.’’
This enables them to concentrate on the operative or
surgical part during the last two years of training.
Social programme
The social programme included the Welcome BBC, a
dinner with the major sponsors and the Final Dinner.
The international participants were warmly welcomed
and introduced on the first day by Richard Grills,
Deputy Chair & Board of Urology Member and the
extraordinary Mrs. Deborah Klein, who is responsible
for organising the Trainee Week. Whenever there
were queries or a problem before or during the
meeting, Deborah was always there to provide help.
The openness and friendliness of the Australian
trainees also helped the international participants to
feel welcome and I guess everybody made new
friendships and returned home with new ideas. It is
also an amazing thing for me to realise that one can
travel to ‘’the other end of the world’’ and come to
meet people who also previously worked with ones
colleagues. All these contacts can perhaps lead to
professional cooperation or the chance to work
abroad.
It was my first time to visit Australia and I regretted
that I didn’t have enough time to arrange for a longer
stay. It would have been interesting to also visit an
Australian department of urology or see more of this
fascinating country. But it won’t surely be the last
time that I will visit Australia.
The skyline of Melbourne
17
Live surgical events: Skills or thrills?
EAU policy on live surgery presented in Milan
Mr. Keith Parsons
Chairman EAU
Guidelines Office
Liverpool (GB)
parsons_keith@
hotmail.com
One of the most successful features of any EAU
Congress is the live surgical sessions, so it is timely to
discuss the EAU position on live surgery.
As in all surgery, things may occasionally go wrong. In
relation to live surgery, however, it is hard to find out
whether they ever do or whether the live surgery
event itself was contributory. Certainly an extensive
literature trawl failed to find any authoritative articles
revealing such information. Nevertheless, there is
sufficient anxiety about live surgical events for a
number of international organisations only to allow
them to take place under strict regulatory control and
for several to ban them altogether.
Why might an organisation be keen, therefore, to
continue to organise live surgical events? Intuitively it
is felt to enhance surgical training, to accelerate the
dissemination of advances in surgery, to promote the
adoption of innovation, and to improve the quality of
care, not least by the audience being able to observe
the very best surgeons performing particular
procedures. There is, however, no firm evidence to
support or refute these suppositions.
The EAU distinguishes between two types of live
surgery:
• ‘Live surgery’ is any surgical procedure
conducted in real time, and observed for
educational purposes. That may of course be
in any surgical department, and part of
general training.
• A ‘live surgical event’ is any surgical procedure
organised for a dedicated audience and
conducted in real time and observed for
educational purposes.
These days the latter might involve a number of
extra people in the operating room, including
camera men and technicians, all present to make
sure that images can be projected in real time to
an auditorium and for there to be interaction
between the audience and the operating team.
the attraction may be the thrill that something might
go wrong. It is rather more likely that the audience
wants to see, not only how an expert surgeon avoids
problems, but if they are encountered, how they are
dealt with.
Faced with a keenness to preserve live surgery events,
and in the light of the anxiety about them, the EAU
Executive Board established an ‘Ethics of Live Surgery
Panel’ charged with the responsibility of investigating
the whole issue and producing a policy on live
surgery for the association. The Panel (Table 1)
comprised members from all the EAU Sections who
use live surgery and other experts with extensive
knowledge about it.
The first step was an extensive literature search, with
no time limit, of all the main data bases. The result
was 306 articles which, using a Prisma Flow chart,
was culled to 81 papers which were circulated to the
panel members. From review of the information, 102
questions on all aspects of live surgery were put to
the panel members in an internet survey.
They included questions on the pros and cons of live
surgery versus video recordings (34); patient safety
(27); ethical aspects (13); regulatory considerations
(12), and the remaining 11 questions dealt with
general aspects of live surgery and the role of
clinicians and organisations. From the polled
answers, the definitions above were determined.
On 15% of other issues there was 100% agreement.
The outstanding issues and principles were then
explored further during an internet e-consensus
conference using the Delphi process. The Delphi
process is a method for structuring group
communication so that the process is effective in
allowing a group of individuals, as a whole, to deal
with a complex problem. How it works is that a
question is posed and anonymous votes are cast.
At the end of the round, each panel member can see
the cumulative results of all the panel member’s votes
and reflect upon them. This is then followed by
re-iterative rounds, where an individual’s vote in the
next round is informed by knowledge of the group’s
results of previous rounds. In this way, a consensus, if
it is to be found, can be drawn together. In the
e-consensus conference, which had 3 rounds, a
consensus level of 80% was used. Thirty-three
questions were put and a consensus was achieved in
70% of the issues.
Table 1: EAU Ethics of Live Surgery Panel
Screenshot Consensus-finding software
2.The over-riding principle is that patient safety must take priority over all other considerations in the
conduct of live surgery
3.All EAU endorsed live surgical events must be organised by a specifically identified local organising
committee with a designated director
4.This committee will report to, and act under the auspices of the EAU Live Surgery Committee who
will authorise the event, ensure compliance with requirements, and establish and maintain a
database of all EAU live surgical events
A draft policy statement and a series of supporting
documents were then written, which embodied all
the issues where greater than 80% agreement was
found on the internet survey and where there was a
formulated consensus from the e-consensus
conference. These draft documents were then
discussed and finalised at a one-day Panel
Symposium which ratified the policy and the
supporting documents.
The supporting documents include a definition of the
local live surgery event committee and its
requirement to appoint a director who will liaise with
the EAU Live Surgery Committee (EAU-LSC) (Table 2).
Application for an event must be made to this
committee using a live surgery procedure checklist,
available online. Within that application is the
requirement that a defined Code of Conduct must be
adhered to and a structured process in organising the
event must be followed.
Table 2: EAU Live Surgery Committee (EAU-LSC)
W. Artibani
EAU Executive Committee,
Chairman
K. Parsons
Guidelines Office
A. Stenzl
Scientific Congress Office
J. van Moorselaar
ESU
L. Martinez-Piñeiro
Section Office
Th. Pieuchaud
ERUS
T. Knoll
EULIS
J. Heesakkers
ESFFU
J. Rassweiler
ESUT
L. Denis
Patient representative
A consent form addendum, specific for live surgery,
must be signed by the patient. Translations of it are
available.
Mr. Parsons presents the new EAU policy on live surgery at the
28th Annual EAU Congress in Milan
Finally, there must be a commitment in advance that
all outcomes and any complications must be reported
to the EAU-LSC, using the standard EAU approved
reporting complications pro-forma as agreed by the
appropriate guideline.
The benefits of this new policy are numerous. The
patient’s safety will be paramount, and they will have
clear information about the event, and meet the
surgeon involved the day before. There will be an
advocate to safeguard their interest. The organising
centre will have a clear framework within which to
plan and execute the event. The surgeon(s)
responsibilities will be explicit, and there will be no
surprises on the day of surgery, having been able to
review patient data well in advance. The surgeons
will have the chance to ensure that all their
preferences are met and any requirements are
available in the operating room. The audience will
have informed moderators, and be able to participate
in a structured dialogue via a moderator in the
operating room with the surgical team.
The EAU has the opportunity to acquire prospectively
audited information about all aspects of live surgery,
and will be able to determine its safety with authority.
Finally, there will be a cumulative database compiled
affording further research opportunities, particularly
in the area of the educational value, and benefits of
live surgery. In this way, the gap in the evidence base
about live surgery, and whether it does achieve it
aims, will be filled.
EAU Executive Committee
ESUT
External consultant
ESOU
ERUS
ESGURS
Expert
Expert
ESUT
ESFFU
SPO
EULIS
EAU Section Office
Editor-in-Chief Eur Urol
ESU
ERUS
ESU
EAU Guidelines Office
ERUS
ESUT
ESUT
ESUT
EAU Scientific Office
ESU
ERUS = EAU Robotic Urology section, ESFFU = EAU
Section of Female and Functional Urology, ESGURS =
EAU Section of Reconstructive Urology Surgeons, ESOU
= EAU Section of Oncological Urology, EULIS = EAU
Section of Urolithiasis, ESU = European School of
Urology, ESUT = EAU Section of Uro-Technology,
SPO = EAU Strategy Planning Office
18
1. The EAU endorses the use of live surgery as a technique for the dissemination of surgical
knowledge, and does so provided that it is organised within a clearly defined regulatory framework
A new feature of the policy is the appointment of a
patient’s advocate who will be a local senior
urological surgeon, not involved in the organising of
the event, but who will be in the operating room with
the sole responsibility of looking after the patient’s
best interest and who has the authority to terminate
the live surgery if deemed necessary.
Live surgical events at EAU Congresses are always
extremely popular and it is sometimes claimed that
W. Artibani
C. Abbou
R. Boscolo
M. Brausi
B. Challacombe
S. Deger
V. Ficarra
G. Guazzoni
B. Guillonneau
J. Heesakkers
D. Jacqmin
T. Knoll
L. Martinez-Piñeiro
F. Montorsi
J. Van Moorselaar
A. Mottrie
J. Palou Redorta
K. Parsons
Th. Piechaud
A. Rane
J. Rassweiler
J. De La Rosette
A. Stenzl
R. Van Velthoven The EAU policy on Live Surgery:
Ethics of Live Surgery Panel gathered for the Panel Symposium in Munich
March/May 2013
European Urology Forum 2013
http://esudavos.uroweb.org
Davos meeting features challenging insights
The 22nd Annual EAU Winter Forum, chaired by
Professors Chris Chapple and Joan Palou and held
from February 2 to 5, 2013 in Davos, Switzerland
proved to be an outstanding success with 200
attendees.
The busy academic programme was supported by a
distinguished faculty of experts composed of: P.
Abrams, Bristol (GB), C. Abbou, (FR), W. Artibani,
Verona (IT), W. Aulitzky, Vienna (AT), D. Castro Diaz,
Sante Cruz de Tenerife (ES), C.R. Chapple, Sheffield
(UK). F.M.J. Debruyne, Arnhem (NL), C. Evans,
Sacramento (USA), P. Mulders, Nijmegen (NL), J.M.
Nijman, Groningen (NL), J. Palou, Barcelona (ES), A.
Patel, London (GB), J. Rassweiler, Heilbronn (DE), C.
Stief, Munich (DE), H.G. Van Der Poel, Amsterdam
(NL), and M. Wirth, Dresden (DE).
The meeting opened with the popular session on
‘What is New in Urology…’ which covered topics such
as andrology and erectile dysfunction, targeted
therapy for uro-oncology, endourology, laparoscopy,
Botulinum toxin in urology, imaging prostate cancer,
bladder cancer, paediatric urology and robotics.
Key note lectures reviewed the contemporary
management of non-invasive bladder cancer, the role
of ablation therapy for organ-confined prostate
cancer, upper tract ureteroscopy: where do we stand
in 2013?, the impact of beta three agonists for
overactive bladder, quality assurance in urology,
advances in medical uro-oncology, contemporary
practice for bladder cancer, managing infertility and
the management of early stage prostate cancer,
among others.
Hands- on-training in ureterenoscopy and
transurethral resection were supervised by a faculty
comprised of A. Breda, Barcelona (ES), J-T, Klein
Heilbronn (DE), C.M. Scoffone, Turin (IT), O. Traxer
Paris (FR). Hands-on training on URS and TUR are
supported by an unrestricted educational grant from
Karl Storz GmbH & Co.KG
European Urology
Forum 2014
Other sessions included Interactive case study
sessions on paediatric and functional urology and tips
and tricks for urethroplasty, upper tract endoscopy
and radical cystectomy.
Another important and much valued aspect of the
meeting, and which has now become an essential part
of the programme, is the “Challenge the Experts
Forum” where a superb faculty of young experts pitted
their knowledge and wits against the faculty. The
young challengers presented three lectures each on
topics of their choice and are challenged on these
presentations by the faculty and the audience. Superb
presentations were given by the young academic
faculty, namely M. Binbay (TR), C. Gingu (RO), L. Peri
Cusi (ES), M. Roupret (FR) and A. Salonia (IT).
Challenge the experts
1-4 February 2014, Davos, Switzerland
EAU meetings
and courses
are accredited
by the EBU in
compliance with
the UEMS/EACCME
regulations
Frans Debruyne, founding organiser of the Winter
Forum, chaired and moderated the competition and
brought to the sessions his unmistakeable incisive
style and with an intellect that guarantees the success
of this competition. In this hard fought contest with
very high standards, M. Roupret (Paris, FR) triumphed
and won the first prize.
Between the morning and evening academic
sessions, participants also had access to the extensive
EAU Video Library of surgical procedures. Participants
highly appreciated the scientific programme and
despite the intensive scientific sessions, the location
and meeting venue provided ample opportunities for
relaxation and sports.
The substantial and stable number of regular attendees
demonstrates the success of this annual meeting, with
familiar faces attending year after year for their regular
updates and continuing medical education (CME).
We welcome and hope to see you next year from
February 1 to 4, 2014!
European
Association
of Urology
Prof. Chris Chapple - Course director
Prof. Joan Palou - Course director
European School of Urology
Activities 2013-2014
Organised courses at National Urological Society meetings
December
May
4
17
31
ESU organised course on Place and role of lymphadenectomy in urologic
cancers at the time of the national congress of the Romanian Association
of Urology
ESU organised course on Pushing back the boundaries in CRPC and UTI
at the time of the national congress of the Estonian Urological Association
Bucharest (RO)
Tartu (EE)
June
13
22
September
6
ESU organised course on Update in non-muscle invasive bladder cancer
T1G3 and nephron sparing surgery at the time of the national congress
of the Polish Urological Association
Jachranka (PL)
ESU organised course on Prostate cancer at the time of the national
congress of the Hungarian Association Urology
ESU organised course on Female urology; fundamentals of stress
incontinence and prolapse at the time of the national congress of the Czech
Urological Society
ESU organised course on at the time of the national congress of the
Jordanian Association of Urological Surgeons
ESU organised course on Localised prostate cancer at the time of the
national congress of the Turkish Urological Association
ESU organised course on Update in urooncology at the time of the national
congress of the Scientific Society of Urologists of Uzbekistan
ESU organised course on Update and evolving investigation in urology
at the time of the national congress of the Russian Society of Urology
ESU organised course on Lasers and endoscopes in urology:
What an urologist should know at the time of the national congress of
the French Association of Urology
Eger (HU)
Salzburg (AT)
15-17
6th ESU Masterclass on Female and functional reconstructive urology,
in collaboration with the EAU Section of Female and Functional Urology (ESFFU) Berlin (DE)
November
ESU Medical oncology course on Genitourinary Cancer (MOGUC)
Marseille (FR)
Residents course
September
Carlsbad (CZ)
Amman (JO)
13-18 11th European Urology Residents Education Programme (EUREP)
Prague (CZ)
Combined EAU/ESU meetings
July
Antalya (TR)
Tashkent (UZ)
12-13
Chinese Urology Education Programme (CUEP)
Beijing (CN)
CUA-EAU programme on LUTS and Oncology
Beijing (CN)
October
15-16
Moscow (RU)
February 2014
1-4
European Urology Forum 2014 – Challenge the experts
Davos (CH)
Paris (FR)
ESU Office T +31 (0)26 389 0680 F +31 (0)26 389 0684 [email protected] www.uroweb.org
March/May 2013
ESU – Weill Cornell Masterclass in General urology
November
14
November
1
4
7
22
July
Teaching course
October
26
31
31
Masterclasses
7-13 ESU organised course on Interventional therapy for BPO - Surgical treatment for
BPO at the time of the national congress of the Slovak Urological Association
Trnava (SK)
ESU organised course on at the time of the national congress of the
Belarusian Association of Urology
Minsk (BY)
ESU organised course on Paediatric urology for the adult urologist:
A practical update at the time of the national congress of the Egyptian
Association of Urology
Sharm el-Sheikh (EG)
ESU courses are accredited within the
programme by the EBU with 1 credit per hour
19
Optimising management of non-muscle invasive TCC
ESUT-ESOU Expert Meeting in Davos
Prof. Thorsten Bach
Asklepios Hospital
Harburg
Dept. of Urology
Hamburg (DE)
t.bach@
asklepios.com
Professors Jens Rassweiler (Heilbronn, DE) and
Mauricio Brausi (Modena, IT) organised the second
meeting of the EAU Section of Urotechnology (ESUT)
and the EAU Section of Oncological Urology (ESOU) in
Davos on February 2 this year in Davos, Switzerland.
Around 40 participants including urologists,
researchers and industry representatives participated
in this all-day meeting on strategies to optimise the
diagnosis and treatment of non-muscle invasive
urothelial cancer.
The meeting focused on all possible aspects of
dealing with transitional cell carcinoma (TCC),
including up-to-date diagnosis and future options to
improve cancer detection as well as surgical
treatment options, comparing standard treatments
with new approaches and discussing future
developments. Furthermore, postoperative treatment
concepts, in particular the role of instillation therapy
was discussed and critically reviewed by the expert
participants.
Diagnostics and imaging
Concerning diagnostics and imaging, photodynamic
diagnosis (PDD) using Hexvix™ has become standard
of care, leading not only to increased detection rate
and decreased rates of residual tumour, but also to a
decreased recurrence rate as Prof. Stenzl (Tübingen,
DE) pointed out. Despite this promising improvement,
other diagnostic options are pushing the frontiers.
While PDD is only available in the bladder, digital
imaging techniques like NBI (Narrow Band Imaging,
Olympus) or SPIES (Storz Professional Image
Enhancement System, K. Storz) [Fig. 1] offers
improved cancer detection not only in the bladder, but
also in the upper urinary tract. An exciting diagnostic
option was presented by Prof. De la Rosette
(Amsterdam, NL). He showed the initial results from
OCT (Optical Coherence Tomography) [Fig. 2], which
enables the assessment of tumour extension and
infiltration depth, especially of upper urinary tract
tumours with high sensitivity and specificity.
Treatment
Transurethral resection of the bladder remains the
reference standard for the surgical treatment and
staging of bladder cancer. In the light of well-known
limitations, like tumour slicing throughout the
resection and incomplete primary resection, it is
necessary to stress the importance of correctly
performing bladder tumour resection, including the
necessity to obtain a specimen of the muscular layer
to allow correct staging. Bipolar resection of bladder
tumour - but also vaporisation of the tumour with
resection only of the tumour base - is gaining higher
acceptance and was advocated as standard approach
by Professors Janetschek (Innsbruck, AT) and
Rischmann (Toulouse, FR).
Fig. 1: SPIES for enhanced tumour detection (Courtesy K. Storz,
Germany).
BCG maintenance therapy plays an important role in
intermediate- and high-risk non-muscle invasive
TCC. In intermediate-risk tumours one year of
maintenance therapy seems to be sufficient, while
high-risk tumour patients should be kept on
maintenance for three years, to achieve the best
possible outcome, as shown by Prof. Chlosta (PL). In
terms of effectiveness, data supports a superiority of
Fig. 2: OCT in Upper Urinary Tract TCC (Courtesy J. de la Rosette, Connaught-strain over Tice and pre-existing
The Netherlands)
immunisation may be beneficial. Finally, optimising
strategies for instillation therapy were discussed and
preliminary data of the potential benefits of
En-bloc resection of bladder tumours provides
thermochemotherapy were presented by Mr. Eshel
complete resection, or even enucleation of the
(Tel Aviv, IL), who proposed improved outcome with
tumour, without tumour fragmentation and the
high-flow heated chemotherapy (MMC at 47°) and
potential risk of tumour cell dispersal and seems
even prolonged disease-free intervals using prepossible for tumour sizes up to 3 cm in diameter
TUR-B chemotherapy instillation.
[Fig. 3]. Various devices, including water-jet, laser as
well as mono- and bipolar hooks are used within
The participants had a comprehensive and productive
clinical trials to evaluate the clinical efficacy. However, ESUT/ESOU meeting, examining crucial aspects of the
although the experimental data seems very
modern management and future trends in nonpromising, clinical data is insufficient so far and the
muscle invasive TCC.
results of on-going trials need to be awaited, before
any evaluation of these techniques will be possible.
“Gathering a group of experts from different fields in
this focused, open and unbiased meeting makes
possible for us to identify the prospects and
directions of modern disease management,” said
“...OCT (Optical Coherence
Rassweiler.
Tomography), which enables the
assessment of tumour extension
and infiltration depth, especially of
upper urinary tract tumours...”
Instillation therapy
Early instillation chemotherapy should be standard of
care in all singular low-risk tumours to reduce
re-implantation of tumour cells, while the effect
seems negligible in patients with multiple, recurrent
or large and high-grade tumours.
Fig. 3: En bloc laser enucleation of papillary tumour of the
bladder (Courtesy T.R.W. Herrmann, Germany)
http://seem.uroweb.org
ESU Medical Oncology course on Genitourinary Cancer (MOGUC)
at the occasion of the 5th EMUC
Place
Date
Chair
Marseille, France
14 November 2013
J. Palou, Barcelona (ES)
H. Van Poppel, Leuven (BE)
08.00
Genitourinary cancer: urologist and
oncologist
J. Palou, Barcelona (ES)
11.45
Testis cancer: chemotherapy according
to histology and stage
G. Kramer, Vienna (AT)
S. Osanto, Leiden (NL)
08.05
Pre knowledge test
12.15
Lunch
08.30
Kidney cancer: surgery or targeted
therapy in local recurrence and
metastatic disease. Why, which and
when.
M. Kuczyk, Hanover (DE)
13.15
Testis cancer: cases in daily practice
G. Kramer, Vienna (AT)
S. Osanto, Leiden (NL)
09.00
09.30
Kidney cancer and metastatic disease:
evaluation and sequential treatment.
New advents in immunotherapy.
B. Escudier, Villejuif (FR)
Interactive case discussion
M. Kuczyk, Hanover (DE)
B. Escudier, Villejuif (FR)
10.00
Break
10.15
Prostate cancer: concepts and daily
management in metastatic disease.
Hormonal therapy
N. Mottet, Saint Etienne (FR)
10.45
11.15
Prostate cancer: drugs available in the
last years. When and why? And the
vaccines? Let´s be clear
S. Chowdhury, London (GB)
Interactive clinical case discussion
S. Chowdhury, London (GB)
N. Mottet, Saint Etienne (FR)
EAU 9th South
Eastern European
Meeting (SEEM)
1-3 November 2013, Thessaloniki, Greece
EAU meetings
and courses
are accredited
by the EBU in
compliance with
the UEMS/EACCME
regulations
13.45
Bone therapy: mechanism of action,
useful, when and in which GU
tumours?
K. Miller, Berlin (DE)
14.15
14.45
Break
15.00
Bladder cancer: what it is the advised
combination therapy and when. Unmet
medical needs in bladder cancer.
J. Bellmunt, Barcelona (ES)
F. Witjes, Nijmegen (NL)
15.30
J. Bellmunt, Barcelona (ES)
F. Witjes, Nijmegen (NL)
Call for Abstracts
16.00
Post knowledge test
deadline 1 August 2013
16.30
Close
For more information please go to
www.uroweb.org
European
Association
of Urology
20
March/May 2013
ESU - Weill Cornell Masterclass in
General urology
EAU meetings and courses are accredited by the EBU
in compliance with the UEMS/EACCME regulations
For more information please contact the EAU Education Office
at [email protected] or go to
http://esusalzburg.uroweb.org
7-13 July 2013, Salzburg, Austria
Sunday, 7 July 2013
Arrival at Schloss Arenberg, check-in and registration
18.00 – 19.00
19.00 – 19.30
19.30 – 20.30
Faculty meeting
Welcome reception
Dinner
11.30
Adrenal surgery: Why and when?
12.30
Lunch
14.00
OMI/AAF Presentation
14.15
Tips and tricks: Vasectomy,
varicocelectomy
Monday, 8 July 2013
08.00
Pre Seminar test
09.00
Urethral surgery: Basic principles
10.00
Coffee break
10.30
Urethral surgery update: Technique and
results
11.30
Erectile dysfunction update
12.30
Lunch
14.00
Testosterone replacement: Benefits,
risks, and therapeutic options
C.R. Chapple, Sheffield (GB)
M. Remzi, Vienna (AT)
P. Schlegel, New York (US)
W. Aulitzky, Vienna (AT)
15.30 – 17.00 Cases by participants
J. Walz, Marseille (FR)
08.00
09.00
15.00 – 17.00 Cases by participants
08.00
Infertility update: Advanced therapy and
new insights
09.00
Varicoceles: Action, indications and
surgical repair - current status
10.00
Coffee break
10.30
Adrenal gland: Physiopathology and
diagnostic tests
European
Uroradiology of the kidney masses:
computed tomography (CT), magnetic
resonance imaging (MRI), nuclear
scintigraphy, ultrasound: Why and when
in the diagnosis and follow up?
Treatment of localised renal cell
carcinoma: Technical aspects of open
partial nephrectomy, role of minimally
invasive techniques. role and extent of
lymph node dissection in renal cancer
10.00
Coffee break
10.30
Surgery for advanced and metastatic
renal cancer
S.F. Shariat, Vienna (AT)
11.30
Systemic therapy for advanced and
metastatic renal cancer
S. Tagawa, New York (US)
12.30
10.00
Coffee break
10.30
Penile cancer management of the primary
and the nodes
11.30
Laparoscopic surgery: Tips and tricks and
its use for testicular cancer
15-20 participants
others: free afternoon
Thursday, 11 July 2013
08.00
Association
Testicular cancer: Treatment stage by
stage
of Urology
12.30
Friday, 12 July 2013
08.00
09.00
Peyronie’s disease: New concepts in
management
10.00
Coffee break
10:30
Ejaculatory dysfunction
11:30
16.30
Coffee break
08.00 - 10.00
17.00 - 18.00
Module 5 - Female urinary retention
and bladder emptying disorders
Coffee break
10.30 - 12.30
Module 2 - OAB and mixed incontinence
12.30 - 13.00
Cases by participants
13.00 - 14.00
Lunch break
14.00 - 15.30
Module 3 - Female reconstructive
surgery
F. Burkhard, Berne (CH)
E. Costantini, Perugia (IT)
D. De Ridder, Leuven (BE)
Urethral diverticula
Urethral reconstruction
Vesicovaginal fistula
Ureteric fistula
Radiation fistula and injuries
15.30 - 16.30
D. Castro Diaz, Santa Cruz De Tenerife (ES)
CIC management
Neuromodulation
Module 4 - Imaging of the lut and
gu tract
J.P.F.A. Heesakkers, Nijmegen (NL)
X-ray techniques
MRI
Ultrasound
High risk prostate cancer in 2013: an update
12.30
Lunch
14.00-17.00
17.00
Post Seminar test
18.00
Farewell reception
19.00
Graduation dinner + selection 4
candidates cases
D. Paduch, New York (US)
Saturday, 13 July 2013
Farewell breakfast and departure
For more information please contact the EAU Education Office
Definitions, diagnostics, prevalence
Conservative management
Male slings
Artificial sphincters
Complication management
17.00 - 18.00
Saturday, 16 November 2013
08.00 - 09.00
Module 6 - Female sexual function
Hormonal changes
Sexual abuse
Dyspareunia
C. R. Chapple, Sheffield (GB)
Definitions, diagnostics, classification
Clinical decision making
Conservative and medication
management
Refractory OAB (Btx and
neuromodulation, augmentation)
http://esuberlin.uroweb.org
Friday, 15 November 2013
10.00
Sexually transmitted diseases:
A 2013 update
15-17 November 2013, Berlin, Germany
Definitions, diagnostics, classification
and decision making
Conservative treatment (EAU guidelines)
Surgical management (EAU guidelines)
Lunch break
15-20 participants
others: free afternoon
In collaboration with the EAU Section of Female and Functional Urology (ESFFU)
A. Vaze, Mumbai (IN)
G. Janetschek, Salzburg (AT)
14.00 – 17.00 Hands-on training laparoscopy
6th ESU Masterclass on Female and
functional reconstructive urology
Module 1 - Stress incontinence
Faculty
G. Janetschek, Salzburg (AT)
Lunch
14.00 – 17.00 Hands-on training laparoscopy
Role and indications for chemotherapy
for testicular cancer
Tuesday, 9 July 2013
09.00
Wednesday, 10 July 2013
09.00 - 11.00
08.00 - 10.00
Coffee break
10.30 - 13.00
Module 8 - Bowel
K. Matzel, Erlangen (DE)
Anal incontinence
Constipation
13.00 - 14.00
Lunch break
14.00 - 15.00
15.00 - 17.00
Module 9 - Male incontinence
Module 11 - Neurogenic bladder
Neuroanatomy related to type of bladder
dysfunction
Conservative management
Surgical management
Urodynamic follow-up of patients with
neurogenic bladder
Complication management (chronic UTI,
stones, renal failure, deteriorating hand
function)
11.00 - 11.30
Diagnosis, classification
Prophylaxis
EAU guidelines
D. Castro Diaz, Santa Cruz De
Tenerife (ES)
K. Matzel, Erlangen (DE)
Sunday, 17 November 2013
Module 7 - Pelvic organ prolapse
Anatomy and clinical examination and
classification (POP-Q)
Vaginal prolapse repair
Abdominal/laparoscopic/robotic
prolapse repair
Mesh or no mesh
Complications: classification and
management
The frail and elderly
Module 10 - UTI
Faculty
10.00 - 10.30
Coffee break
10.30 - 11.30
Module 12 - Chronic pelvic pain
Definitions, prevalence, etiologies
EAU guidelines on assessment and
treatment algorithm
11.30 - 12.30
Module 13 - Diversion surgery for
functional reasons
Decision making
Surgical techniques (Bricker, neo-bladder,
Monti-Yang, Mitrofanoff)
12.30
This Masterclass is accredited
within EU-ACME programme
by EBU with credit points
Adjournment
European
Association
of Urology
March/May 2013
21
Young Urologists/Residents Corner
Creating a network of professional contacts
Danish resident gives high approval mark to Residents Day
Dr. Pernille Skjold
Kingo
Dept. of Urology
Århus University
Hospital
Århus (DK)
pernille.skjold@
stofanet.dk
As in previous years, the Young Urologists Office
(YUO) in collaboration with the European Society of
Residents in Urology (ESRU) organised a special
session for young urologists, and presented a
day-long programme that featured many excellent
and inspiring lectures by urology experts.
The main topic focused on how to prepare young
urologists after residency training with a special
emphasis on building up surgical skills, and the need
to be actively involved in national and international
research projects.
A. Mottrie, (Aalst, BE) lectured on robot-assisted
laparoscopy for young trainees, while B.S.E.P Van
Cleynenbreugel, (Leuven, BE) presented a video
session on basic laparoscopic skills. Both
presentations provided a very good insight on how,
when and where the training of these techniques
could be undertaken. They also stressed the
importance for young urologists to master the basic
skills needed in the work-up of diagnosing urological
diseases such as prostate cancer.
L.N. Türkeri (Istanbul, TR) gave a very thorough and
useful presentation on how to perform a TRUS-
guided prostate biopsy. Meanwhile, O. Traxer (Paris,
FR) explained how to perform a good PCNL and when
to choose the mini-perc and the standard
nephrectoscope.
ESRU’s former chairman M.E. Silay (Istanbul, TR) gave
an overview of the trends in paediatric urology, and
noted that due to improvements and development of
smaller and better laparoscopic and endourologic
equipment during the last decade this has led to a
great change in the treatment regimens for paediatric
patients. He said many of the paediatric procedures
that used to be performed by open procedure are
now more commonly performed by either laparoscopy
or endoscopy.
F.M.E. Wagenlehner (Gieβen, DE) thoroughly discussed
the different antibiotics and resistant patterns, and
stressed the fact that with the use of many antibiotics,
organisms are becoming more and more resistant,
and as a consequence patients no longer respond to
treatment, and in worst case scenarios can even lead
to urosepsis. One of his take home messages is to
check the resistant pattern if a patient don’t respond
to the prescribed antibiotic instead of simply
prolonging the treatment with the same antibiotic. He
also urged urologists to use antibiotics wisely and
include it in their treatment strategy only when
indicated.
of the main causes of this phenomenon is due to
couples who decide to have a family at a later age.
gave the participants the opportunity to actively
interact with the experts.
Career choices
Another topic discussed was making the choice for a
primarily academic or clinical career after residency
training. An interesting debate on the subject was
presented by S. Al Hayek (Cambridge, GB) and E.B.
Cornel (Hengelo, NL), and both presenters made
convincing arguments. In the end, young urologists
have to decide for themselves, whilst taking into
careful consideration the opportunities and
drawbacks in either the academic or clinical practice.
The programme ended with the Nightmare Case
session, with three challenging cases presented by
young urologists. All cases were very informative,
well presented and prompted a good discussion
regarding diagnosis, treatment and identifying
potential complications.
The social programme included a dinner which
provided the opportunity for the residents to get to
know each other in a more relaxed setting.
The Residents Day met my expectations, and served
very well its aim to provide a platform for young
urologists to share experiences and network with
colleagues from other countries. The speakers’
messages reiterate the need to work hard, practising
and refining one’s skills and engaging in innovative
research work. Overall, this annual event is highly
informative and I thank the organisers for a very
productive and memorable day.
As a follow-up to the debate on career choices, A.G.
Van der Heijden (Njimegen, NL), G. Godoy (Houston,
Texas, US), H. Fajkovic (St. Pötten, AT) and S.Larre
(Reims, FR) shared their experiences, advice and tips
on how to secure a scholarship or fellowship, and
how they manage to achieve their career aims
through networking and continued efforts for
self-improvement and skills training. Their
presentations were very inspiring that one feels
encouraged to immediately apply and get started.
Andrologist J.O.R. Sonksen (Herlev, DK) presented a
diagnostic approach and clinical work-up for the
infertile couple. Even though these cases are referred
to experts in specialised centres, the young urologist
needs to know this kind of patient so they can give the
right diagnosis and prescribe the proper treatment for Other highlights were a discussion on the residency
the couple. Interestingly, 8% of all children born
curriculum, the Campbell Quiz session and the
nowadays are conceived through IVI-D or IVI-H. One
presentation from the EAU Guidelines Office which
Dr. Timothy Oedekoven (DE) presenting a Nightmare Case
Endourology fellowship in Pakistan
The Indus Hospital Initiative
Dr. Andreas
Bourdoumis
Endourology and
Stone Services
Barts Health NHS
Trust
London (GB)
bourdoua@
hotmail.com
After completing my training in general urology at the
2nd Department of Urology at Sismanogleio General
Hospital of the University of Athens, Greece, I was
lucky to be appointed as endourology fellow at the
Royal London Hospital in London, UK.
Shortly after the start of this two-year EBU-accredited
fellowship I participated in a charity mission to
Pakistan. This project, called “The Indus Hospital
Initiative” was initiated by my programme director
Mr. Noor Buchholz and aims to bring together a team
of urologists which, using their own finances and free
time, travel to the Indus Hospital in Karachi to support
local urologists.
I consider it a challenge to join a group of experts
who are travelling to a potentially unstable region.
Nevertheless, the opportunity was indeed unique and
presented an opportunity for me to further improve
my skills in advance endourologic procedures.
Dr. Christian Bach
Dept of Urology
Southmead Hospital
Bristol (GB)
Christian.Bach@
bartsandthelondon.
nhs.uk
knowledge transfer. This goal is essential since the
local urologists-in-training have very little
opportunities to travel abroad due to financial and
political circumstances.
Conducting operations with the local urologists
proved to be highly productive as we demonstrated
techniques such as supine PCNL and the “Barts flank
free modified supine position.” We could also learn
from the highly-skilled local urologist who showed
their own technique in prone PCNL using an upper
pole puncture and which has the advantage of
clearing even staghorn stones with only one access. A
total of 11 PCNL and several other urological
procedures were performed during our stay in
Karachi.
Our team consisted of Mr. Noor Buchholz, director of
the Royal London Endourology and Stone Services,
Mr. Islam Junaid, consultant urological and transplant
surgeon, Mr. Christian Bach, former senior
endourology fellow in the Royal London Hospital and
currently fellow in robotics at the Southmead Hospital
in Bristol.
To cover the academic aspect, the director of the
Indus Hospital, Dr. Zafar Zaidi organised a urolithiasis
symposium with a faculty consisting of our own team
and local experts. Important topics included basic
science of stone formation, metabolic aspects,
prevention, modern treatment modalities as well as
future perspectives. Around 50 participants from
Karachi attended this very successful meeting. There
were also participants from the neighbouring cities of
Hyderabad and Bahawalpur and one delegate even
traveled more than 500 km by car from Larkana city!
The mission would focus on sharing our expertise as
doctors from a high-volume stone unit and tertiary
referral centre. The programme would include
mentoring local urologists both theoretically and in
the operating room thereby creating a platform for
But the most impressive, in my view, was our visit to
the Indus Hospital itself which was made possible
due to the commitment and perseverance of a small
group of idealists in a country still facing political
turmoil.
22
A charity institution, Indus Hospital is entirely
a Dornier Sigma ultrasound guided lithotripsy unit
financed with donations and was envisioned by Dr.
and in the very busy outpatient section up to a
Abdul Bari Khan, Dr. Zafar Zaidi, Dr. Amin Chinoy and hundred patients per day come for consultation.
Dr. Akhtar Aziz Khan as a tertiary care centre to
provide quality care for the less privileged. It took
“...deeply impressed by the
more than 10 years from the original conception to the
achievements of the hospital’s four
laying of the hospital’s foundations. The first patients
were admitted in July 2007 and the first surgical
pioneers...”
operation took place in the following month.
The founders of Indus Hospital planned to establish a
modern university hospital of 1,200 beds, with
Located in the Korangi area, in the southern part of
medical, nursing and research schools on site and the
the city, the 150-bed hospital prides itself to be the
first truly eco-friendly hospital in the region. We were improvements will all be entirely funded by donations
and non-profit fund raising. It may seem an
amazed how few disposables were used and how
impossible task, but one only has to hear Zaidi’s view
quick and efficient everything was organised. It has
six operating theatres for adult and paediatric surgical regarding the project: If 100,000 people were
committed to offer 1,000 Pakistani rupees (about 10
procedures, including trauma and orthopaedics,
general surgery, cardiothoracic surgery, urology, ENT, euros) every month for a five-year period, the whole
project would be completed within that time frame,
ophthalmology and dental services. It also offers a
and a sustainable endowment would be created to
six-bed ITU and dedicated endoscopy and
support the infrastructure plans and pay the daily
angiography suites.
functional expenses. And indeed, there is already a
very supportive, mainly Pakistani community of
The urology department is staffed by two consultant
supporters in the country itself. Overseas the project
urologists, Dr. Zafar Zaidi and Dr. Zaheer Alam, one
associate specialist and five residents. The department offers a great opportunity for Pakistani expatriates to
support the home country in an effective and
occupies an entire floor with 36 beds. The workload
sustainable way.
consists mainly of stone surgery, transurethral
operations, upper tract laparoscopic and
reconstructive surgery. A dedicated urologist operates The trip was truly an unforgettable experience for me
and also a great learning opportunity from a medical
and human perspective, giving me a sense of
fulfillment and accomplishment due to its altruistic
goals.
I am deeply impressed by the achievements of the
hospital’s four pioneers and I am also looking
forward to return to Karachi in the future, knowing
that Dr. Buchholz and Dr. Zaidi plan to establish a
charity project.
From right: Mr Bourdoumis, Mr Buchholz, Dr Alam, Dr Zaidi,
Mr Junaid and senior resident Dr Abdul Hafeez Qureshi during
a retroperitoneoscopic nephrectomy
More significantly, this charity hospital would not
exist without the help of many and I strongly
encourage anyone to support this fantastic project.
Visit their website at: http://indushospital.org.pk for
more information or contact Dr. Zaidi directly by
writing to [email protected].
March/May 2013
Young Urologists/Residents Corner
A call for active support
Organisers of Residents’ Day look for more input from young urologists
Dr. Guillermo
Martinez
ESRU Secretary
Member of the Young
Urologists Office
Koper (SI)
esrusecretary@
gmail.com
“Don’t ask what Residents and Young Urologists Day
can do for you...”
I presume readers would know not only the reference
of the statement above, but also what to add and
complete this sentence. And that is why we have
decided to get you involved in deciding what should
next year’s’ Special Session offer. But first of all, let us
recall the Residents Day meeting held a few months
ago.
During the 28th Annual EAU Congress in Milan, and
also in previous congresses, the Young Urologists and
Residents Day Special Session took place on Saturday,
March 16. Organised by the Young Urologists Office
together with ESRU, it was one of the most visited
sessions in the congress with more than 500
participants scanned and a nearly full session hall
throughout the day.
The meeting featured an excellent line-up of speakers
and a carefully prepared programme, precisely
tailored to what we believe would cater to the needs
of young urologists and residents.
various urological specialties. For this session we are
grateful to have the direct support of the European
Board of Urology (EBU) and the EAU, a collaboration
which demonstrates the continued joint effort by
everyone to understand how urological training in
Europe is being performed. Moreover, these efforts
attempt to come up with a common European
urological curriculum that will serve as a reference or
basis of what is to be accomplished during training.
By presenting the perspective of our more senior
colleagues who have all gone through the various
phases of training and education and are now
successful specialists, participants can receive insights
and have an overview on future prospects, tips on
whether to pursue an academic or non-academic
career and scholarship opportunities, among other
key topics. The latter is particularly important for
novice urologists and the speakers certainly provided
helpful suggestions and effective approaches on how
to secure and benefit from fellowships and the
essential preparation needed for a career changing
experience.
The session also examined challenges and future
prospects, with a panel discussing issues such as
employment, migratory and labour trends and how
the current European economic landscape impact on
healthcare issues.
In another session we have addressed the issue of
training and what is expected from a trainee in terms
of knowledge and skills that are required in the
Moreover, a wonderful evidence-based session was
also held, with excellent speakers discussing the
latest evidence in endourology, biopsy techniques,
As in 2012, we also had a presentation from the EAU
Guidelines Office with an update on evidence
analysis, including a live demonstration of the
innovative Internet-based update system. Several
young urologists and residents have been trained by
the EAU Guidelines Office to create teams for evidence
analysis.
Milan Congress: Clockwork efficiency
Italian resident experiences congress for the first time
Dr. Giulio Patruno
University ‘Tor
Vergata’ of Rome
Dept. of Urology
Rome (IT)
g.patruno@
gmail.com
Benvenuti! (Welcome) is one of the first words that
tourists learn when travelling in Italy. ‘Benvenuti a
Milano!’ said Prof. Francesco Montorsi during the
opening ceremony as he formally welcomed more
than 13,000 participants from all over the world who
came to Milan.
As a junior resident, this year’s congress has been
more than just a meeting. The event was my first
European congress and brought me for the first time to
Milan, Italy’s second biggest city and the country’s
economic and financial hub. Here Piazza Affari (as the
stock exchange is nicknamed) operates 24 hours a day
with thousands of bankers crowding Milan’s busy
streets.
The congress was impressive and the efficient
organisation was reflected in the timely arrival of
shuttle buses that picked up the delegates from the
closest metro station. At the congress venue everything
ran with clockwork precision, from the welcome,
registration, information to the friendly staff members.
My fellow Italian ESRU National Communication Officer
(NCO), Dr. Gianluca Salerno and I attended the ESRU
Board meeting on Friday afternoon before we
proceeded to the opening ceremony which featured an
opera performance from La Scala. After the ceremony,
and following Milanese tradition, aperitivi was served.
Saturday was the Resident’s Day, which gave me an
opportunity to look into the experiences of residents in
other European countries. Excellent reports and great
lectures covered many key urology topics, ranging from
surgical to medical treatment strategies, from
paediatric to functional urology, to name a few. Big
questions faced by residents were also examined such
as career planning, clinical practice vis-à-vis an
academe-based profession, and scholarship
opportunities.
More than 400 participants attended and this year the
Campbell’s Quiz challenged many of the residents,
with an Austrian resident beating other participants for
the top prize. In the evening, the Resident’s Dinner
March/May 2013
took place at the Il Gattopardo Cafè, with free drinks
and clubbing late into the night. The evening gave us a
needed break, allowing us to get to know our
colleagues better in an informal and relaxed
atmosphere.
Learning opportunities
The next two days, although hectic, offered many
learning opportunities such as training sessions,
symposia and courses. Hands-on training with
simulators gave us an opportunity to perform new and
more complicated surgical procedures. Being well
trained on simulators provides the benefit of lower
risks when doing actual operations and also shortens
the so-called learning curve.
On Monday, the European Urological Scholarship
Programme (EUSP) session gave a comprehensive
overview of the scholarships and training available to
residents, and Prof. Mirone offered helpful and
detailed information, and showed how a scholarship
can play a crucial role in one’s career development.
I also met old and new colleagues and friends from all
over Europe, and the exhibition hall served as a
convenient meeting point. At the EAU booth, we picked
up copies of the handy pocket version of the 2013
Guidelines and other publications. The ESRU booth
was also located near the EAU’s, and residents got the
chance to receive detailed information about the
association and their activities.
At the final plenary session, the role of PSA screening,
risk and benefits were extensively discussed, including
both the European and American perspectives. Prof.
Per-Anders Abrahamsson concluded his lecture by
emphasizing that men who consider PSA screening
should be aware of the risks and benefits of the
procedure.
Outside the congress, we had the chance to see a little
of Milan. At the Gallery Vittorio Emanuele II, right in
the centre of Milan’s fashionable district near Via
Montenapoleone, the bag and shoe stores have been
quite popular among our female colleagues! In the
Last but not least, we had our annual Campbell’s Quiz
Session. This year one extremely well-prepared
participant won the latest edition of Campbell’s
Urology, surely a well-deserved prize.
For residents, how would you complete or finish the
opening statement in this article? What can you do for
next year’s Special Session? It’s plain and simple: just
let us know what you would like to discuss or be
taken up for next year. Help us understand or alert us
whether we are on the right track or if we need to
focus on something that we have missed. To achieve
this, the ESRU together with the Young Urologists
Office will conduct a survey among our network of
national representatives. The survey questionnaire
should reach you within the next couple of months.
Please do support us and send your feedback.
The ESRU and the Young Urologists Office would like
to thank everyone who contributed to the success of
this year’s Residents and Young Urologists Day. We
look forward to see you next year. With your active
support we hope to organise and present in 2014 an
even better programme in Stockholm, Sweden.
Residents’ Day:
Tips and
challenges
I have attended the AUA Meeting before, but it was
my first time to attend the EAU Congress. Comparing
these congresses I realised that they have the same
impact, coverage and influence.
The Resident’s Dinner presents a chance to get to know
residents from other countries
In the case of the EAU Congress this year, Milan in
Italy as a venue was an ideal choice with its historical
legacy, accessible location and efficient transport
systems. At the congress, I attended the Residents’
Day, certainly an important meeting particularly to
urology residents like me. Attendance to this meeting
was high and the session hall was full during the
plenary meetings.
Gallery there is a “urological” curiosity. At the central
mosaic of the Gallery’s floor, a bull from Turin’s
coat-of-arms is depicted. According to tradition, it will
bring good luck if a person puts his right heel on the
bull’s genitals and turns three times.
The Residents’ Day programme featured lectures and
talks about a career in urology, opportunities for
fellowships and research grants in European and
American clinics, tips on how to develop and improve
one’s research projects and clinical practice, and how
to secure other career or professional opportunities.
Testimonials
As the ESRU-NCO from the host country I have asked
some Italian colleagues for their comments of the
congress. Dr. Marco Casilio, a young andrologist from
the Hospital Villa Tiberia in Rome said: “I really
appreciated the Video Sessions and attended most of
the sessions at the eURO Auditorium. In particular, I
really liked the videos on robot-assisted surgeries.”
In my view this kind of meeting, with its emphasis on
professional skills and properly identifying the various
challenges and prospects in our specialty is important
as it has an influence on the development and growth
of urology as a specialty. With the globalised world
that we live in today it is certainly important to
examine and consider various viewpoints and
opinions.
Dr. Eugenia Fragalà (Catania, Sicily), said: “The
congress was an amazing experience and many video
sessions were extremely interesting. It was great to
watch the best urologists doing live operations. At the
EAU congress, I found only the best!”
Another topic discussed during the meeting was the
current challenges and obstacles faced by residents,
the prospects that we have and how to resolve the
issues on education, training and career
development. A traditional feature in the programme
was the Campbell Team Challenge Quiz session which
I find very informative and enjoyable.
“I liked hands-on courses and I attended “Laparoscopy
for Beginners,” said Dr. Valerio Iacovelli, a resident
from Rome. “The practical approach gave trainees the
right trips and tricks on surgical procedures, and the
relaxed mentoring of our tutors is also very helpful.”
Dr. Marilena Gubbiotti, a resident from Perugia,
appreciated the high quality scientific programme.
“The five days were wonderful and are very helpful for
the growth of young urologists like us. With the
participation of the world best experts, we can only
benefit from this experience.”
The ESRU board at work
infertility, functional urology, paediatric urology to
urological infections, among other topics.
I can only agree with my colleagues as the congress
has been an exciting and rewarding experience. It
served as a window to European and international
urological practice, and a great opportunity to directly
hear from the experts their views on key issues.
After the break, sessions focused on various
urological issues such as an update on guidelines
analysis. The presentation of former ESRU president,
M. S. Sılay on paediatric endourology was not only
well-illustrated with humorous pictures but also
impressive. During the Nightmare Session interesting
clinical problems that have perplexed residents were
discussed with the invited experts. The programme
closed with the awarding ceremony.
Overall, I am glad that I had the chance to attend and
be part of this very well organised Annual EAU
Congress and the Residents’ Day, and I hope that I can
again take part in future meetings.
Dr. Fatih Elbir, Istanbul (TR)
23
Open stone surgery in 2013
With more expertise on minimally invasive procedures, open surgery for stones is declining
Mr. Hammad Ather
Associate Professor
Aga Khan University
Karachi
Karachi ( PK)
hammad.ather@
aku.edu
Mr. Noor Buchholz
EULIS board member
London (GB)
nb@londonurology
consultant.com
to encrusted stent including obstruction and infection.
Forgotten stents can often become encrusted1
involving not only the two coils but sometimes the
whole length of the stent. The best therapy is
prevention. We described the use of an automated
computerised system to track overdue stents which
was able to decrease the number of overdue stents
dramatically from 12.5 to 1.2% within one year since
the start of the programme2.
Matlaga and Assimos3 looked at the trend of open
surgery at Wake Forest University in North Carolina,
United States. They observed that between 1998 to
2002, of 986 procedures performed for the purpose of
stone removal, only 0.7% were open surgical
procedures, compared with the earlier reported rate
of 4.1% in 893 procedures. The two most frequent
indications for open intervention in the two
aforementioned series3,4 were failed endourological
interventions and anatomical abnormalities
precluding endourological surgery.
“Urolithiasis is a highly recurrent
disease. Approximately 50% of
patients will form another stone in
five to seven years...”
between 1987 and 1995 to 8% between 1996 and
1998. However, the remaining indications for open
ureterolithotomy include failure of less invasive
modalities, the presence of medical/ anatomical
abnormalities, a concomitant open procedure, and
the presence of large impacted calculi for which
patients prefer to avoid multiple procedures.
Introduction of shock wave lithotripsy (SWL),
percutaneous nephrolithotomy (PCNL), semi rigid
ureteroscopy (URS) and retrograde intra renal surgery
(RIRS), and laparoscopy all have drastically reduced
the need for open surgery. Indications of open
surgery are currently restricted to complex stones,
failed endourological treatment and anatomical
abnormalities. However, in a well-equipped
endourological centre with appropriate expertise
almost all urinary tract stones can be dealt with in a
minimally invasive fashion avoiding open surgery
nowadays.
References
Ather et al.5 have looked at the need for open surgery
for ureteral stones in a developing country and noted
The management of urolithiasis has seen a paradigm that with recent advances in endourology the
shift. Open surgery was the predominant modality up indications for open surgery have decreased
considerably, from 26% between 1989 and 1995 to
to the 1980’s. Today, it is hardly done any more in a
8% between 1996 and 1998. However, the remaining
well-equipped endourological unit.
indications for open ureterolithotomy include failure
of less invasive modalities, the presence of medical/
Current indications of open surgery are limited and
anatomical abnormalities, a concomitant open
are becoming increasingly more limited with
procedure, and the presence of large impacted calculi
advances in endourology and laparoscopy. These
indications include complex stone burden, anatomical for which patients prefer to avoid multiple
procedures.
abnormalities precluding endourological
interventions, and as a salvage procedure following
failed endourological interventions.
“Besides costs, patient compliance is
Renal stones
Complex renal stones are considered as a possible
indication for open surgery. Complexity of renal
stones can be defined based on stone- and patientrelated factors. However, its definition is highly
relative and widely surgeon- and centre-dependent.
The stone related factors include stone-burden,
-distribution and calyceal anatomy. Patient-related
factors include body habitus (in particular spinal
deformities), co-morbidities, use of anticoagulants
and bleeding diathesis, and patient compliance.
Indication of open surgery is heavily dependant on
the availability of endourological armamentarium and
expertise. Cost is another important consideration, as
minimally invasive surgery (MIS) may require multiple
procedures and numerous disposables. Besides costs,
patient compliance is another important factor in
choosing MIS for complex renal stones.
Urolithiasis is a highly recurrent disease.
Approximately 50% of patients will form another
stone in five to seven years following their first stone
episode8. The treatment of recurrent large burden
renal stones with a history of previous open surgery is
particularly challenging due to the altered
retroperitoneal anatomy. Gupta and colleagues noted
that patients undergoing PCNL with a past history of
renal stone surgery may need more attempts to
access the pelvi-caliceal system and have some
difficulty in tract dilatation because of retroperitoneal
scarring. However, overall morbidity and efficacy was
the same in both, patients with or without previous
open stone surgery9.
another important factor in choosing
MIS for complex renal stones.”
In our experience, even in a developing country
scenario, the indications for open surgical
intervention for renal stones have decreased
dramatically6. The rates of open surgical intervention
for renal stones in 2010, 2011, and 2012 were 4.5, 3.7
and 3.9%, respectively. This is not only due to
advances and easier availability of endourological
techniques, but also to increasing awareness and
desire of the patients for less invasive procedures.
Interestingly, the increasing trend in MIS does not
result from evidence-based direct comparisons. There
are no good head-to-head trials comparing various
endourological interventions and open surgery.
Recently Barack and colleagues7 compared open
surgery and PNL for pediatric renal stones. They noted
Another relative indication for open surgical
intervention may include neglected, heavily encrusted that PNL has superiority over open surgery with
stents. Patients can present with complications related regards to in-patient stay, transfusion, and rate of
stenting. However, the stone free rate 91% for PCNL
and 85% for open surgery were not statistically
EAU Section of Urolithiasis (EULIS)
significant different (p = 0.318).
The 2011 EAU Guidelines provide a comprehensive list
of indication for open surgery. Complex stone burden
is the foremost indication for open stone surgery.
However, complex stone burden remains a poorly
defined term as complexity may result from stone
burden, intra-calyceal distribution, calyceal anatomy,
renal anatomy and concomitant abnormalities like
UPJO. Another determining factor is the availability of
endourological armamentarium and the level of
expertise.
Ureteral stones
As far as ureteral stones are concerned, optimal
treatment modalities for large proximal ureteral
stones are controversial, and include SWL,
ureteroscopic stone fragmentation, PCNL, laparoscopic
ureterolithotomy and open surgery.
There has been some good quality evidence. A
recently reported small RCT from Brazil9 compared
SWL, ureteroscopy and laparoscopic ureterolithotomy
and noted that large proximal ureteral stones often
require multiple procedures to achieve stone-free
status. Laparoscopic ureterolithotomy, as compared
with SWL or ureteroscopy, may achieve higher
stone-free rates and fewer re-treatments, but is
associated with more postoperative pain, a longer
procedure time and hospital stay. Almeida and
colleagues10 in a prospective non-randomised trial
compared open and laparoscopic ureterolithotomy
and noted that laparoscopy offered significant
advantages over open ureterolithotomy, resulting in
improved analgesia and shorter hospital stay, with
similar complication rates
The rate of open surgery for ureteral stone has not
only declined in the west but also in developing
countries. As mentioned above, Ather et al.5 reported
a reduction in the number of open operations
performed in their hospital in Pakistan from 26%
1. Vanderbrink BA, Rastinehad AR, Ost MC, Smith AD.
Encrusted urinary stents: evaluation and endourologic
management. J Endourol 2008;22(5):905-12.
2. Ather MH, Talati J, Biyabani R. Physician responsibility for
removal of implants: the case for a computerized
program for tracking overdue double-J stents. Tech Urol
2000;6(3):189-92.
3. Matlaga BR, Assimos DG. Changing indications of open
stone surgery. Urology. 2002;59(4):490-3.
4. Assimos DG, Boyce WH, Harrison LH, McCullough DL,
Kroovand RL, Sweat KR. The role of open stone surgery
since extracorporeal shock wave lithotripsy. J Urol
1989;142:263-7.
5. Ather MH, Paryani J, Memon A, Sulaiman MN. A 10-year
experience of managing ureteric calculi: changing trends
towards endourological intervention - is there a role for
open surgery? BJU International 2001;88:173-177.
6. Ather MH. Open surgery for stones in 2012. Experts in
Stone Disease conference (ESD 2012), Dubai, UAE, 13-16th
Dec 2012.
7. Bayrak O, Seckiner I, Erturhan S, Duzgun I, Yagci F.
Comparative analyses of percutaneous nephrolithotomy
versus open surgery in pediatric urinary stone disease.
Pediatr Surg Int 2012;28:1025–1029.
8. Pramar MS. Kidney stones. BMJ 2004;328(7453):1420-4.
9. Gupta R, Gupta A, Singh G, Suri A, Mohan SK, Gupta CL.
PCNL--A comparative study in nonoperated and in
previously operated (open nephrolithotomy/
pyelolithotomy) patients--a single-surgeon experience.
Int Braz J Urol 2011;37(6):739-44.
10. Lopes Neto AC, Korkes F, Silva JL 2nd, Amarante RD,
Mattos MH, Tobias-Machado M, Pompeo AC. Prospective
randomized study of treatment of large proximal ureteral
stones: extracorporeal shock wave lithotripsy versus
ureterolithotripsy versus laparoscopy. J Urol
2012;187(1):164-8.
11. Almeida GL, Heldwein FL, Graziotin TM, Schmitt CS,
Telöken C. Prospective trial comparing laparoscopy and
open surgery for management of impacted ureteral
stones. Actas Urol Esp 2009;3(10):1108-14.
Endourology course in Torino, Italy
Enthusiastic response to EULIS-ESUT sponsored training
Dr. Cesare Marco
Scoffone
Cottolengo Hospital
Urology Unit
Turin (IT)
[email protected]
The second edition of the Technology and Training in
Endourology Course directed and organised by the
author together with Drs. Cecilia Maria Cracco and
Fabiola Liberale, took place from 8 to 10 November
last year at the Cottolengo Hospital of Turin, Italy.
urologists participated in this training which aimed to
provide a dynamic exchange of endourological tips
and tricks, define the various steps of minimally
invasive procedures and deepen their knowledge of
technologies that we regularly employ to optimise
clinical results.
The format of the course, conceived by the author and
which was successfully implemented in 2011, included
live surgeries performed by both selected experts and
young urologists under tutorship. This year the
procedures were Endoscopic Combined IntraRenal
Surgery (ECIRS), Retrograde IntraRenal Surgery (also
with digital instruments), bipolar TURB and TURP,
HoLEP, vapoenucleation with Green Laser and ThuLEP.
The quality of audio-visual transmission of both
retrograde and antegrade endoscopic images,
This initiative was created in 2011 under the
together with fluoroscopy, ultrasound and
sponsorship of the Italian Society of Urology (SIU), the environmental shots, was outstanding, thanks to the
Italian Society of Endourology (IEA), and the European complete optic fiber wiring of the urologic operating
Association of Urology (EAU) sections EULIS and ESUT. room, and the efficient work of the technicians. The
A very practical and interactive course, 70 young
active contribution of session moderators who
provided insightful comments yielded informative and
enlightening perspectives regarding the various steps
EAU Section of Urolithiasis (EULIS)
of the procedures.
24
Besides the live surgeries, the programme included
roundtable discussions and focused commentaries,
which this year covered a wide range of topics, such
as the following: the pre-operative cooperation
between urologists and radiologists, laboratory and
endoscopic diagnosis of urolithiasis, prevention of
recurrences, endoscopic approach in children,
irrigation systems and the risk of high intrarenal
pressures, pros and cons of all therapeutic
approaches for urolithiasis, physical principles of
lasers, training issues, technical issues on the various
approaches in the treatment of LUTS, providing
assistance or the use of flexible instruments, the
between the audience and experts was stimulating
various steps of RIRS (access, irrigation, lithotripsy,
extraction of stone fragments, final stenting) and legal and for three days the session hall was full
aspects regarding informed consent.
throughout the meeting. Not only was the atmosphere
friendly and relaxed, participants said they felt free to
The faculty included well-known endourologists from ask and convey their point of view.
all over Europe such as Olivier Traxer (Paris, FR),
Thomas Knoll (Sindelfingen, DE), Alberto Breda
Overall, we had a very positive and successful
(Barcelona, ES), Palle Osther (Fredericia, DK),
Technology and Training in Endourology Course, and
Fernando Gomez Sancha (Madrid, ES) as well as
we believe that all the participants -- both young and
Italian experts Antonio Frattini, Guido Giusti, Agostino veteran urologists- experts) were not only satisfied
Meneghini, Emanuele Montanari and many others.
with the sharing of knowledge and experience, but
All the invited speakers gave original presentations
also benefitted from the new ideas that will inspire
which elicited insightful comments. The discussion
them to face the challenges in endourology.
March/May 2013
Remembering Arthur Barth (1858-1927)
Towering achievements of a modest man
Dr. Thaddaeus
Zajaczkowski
Member History
Office
Muelheim an der
Ruhr (DE)
th.zajaczkowski@
gmx.de
In those days, it was an object of modernity, made up
of 16 pavilions. The complex also included the offices
of the hospital administration, accounts department,
mortuary, operating suites, nurses’ home, boilerroom, and accommodation for doctors, office workers
and staff. The entire complex consists of 26 buildings
and occupies an area of 157,572 m2, when it was
handed over for use in 1911 (Figure 1).
After World War I, in 1921, a start was made to
gradually expand the hospital. In response to the
enormous demand, a 200-bed Skin and Venereal
Prof. Arthur Barth, the first director of the
Diseases Department was constructed. In 1927 the
Department of Surgery at the then newly-erected
Institute of Radiodiagnostics and Radiotherapy
Municipal Hospital in Danzig, died 86 years ago on
Therapy was established, and in 1933, in addition to
May 7, 1927 in Schwerin, Germany.
the Central Laboratory, an Orthopaedic and
Rehabilitation Department was opened in the Surgical
Prof. Barth was a distinguished surgeon. From 1896
Unit. In 1934, the Municipal Hospital had rooms for
to 1911 he worked as Senior Registrar in the surgical
1,160 patients, including 320 beds for surgical
department of the “old” municipal hospital, while
patients.
from 1911 until 1924 he was Director of Clinical Surgery In the centre of this complex stood the two-storey
in the newly-built Municipal Hospital. He primarily
operating block. On the upper floor there was a small
focused on surgery of the genitourinary system.
operating theatre and preparation room, together
with a septic procedure room and preparation room.
The beginning of the hospital service in Gdansk
(Danzig) is closely connected with the arrival of the
During the inter-war period the facility was the most
Teutonic Knights in 1308. The earliest institution to be advanced institution in the Northern Province of
mentioned in historical records is the Hospital of the
Prussia. Doctors employed there, for the most part
Holy Ghost in Gdansk, built in 1310-1311. Run by the
high-level specialists, used to go abroad to perform
Knights Hospitaller until 1382, it was primarily
operations and give lectures.
reserved for the treatment of sick pilgrims, travellers,
and paupers. The passing of the centuries saw the
As the long-serving director of the surgical
gradual development of Danzig’s hospital service.
department in the old municipal hospital (1896-1911),
Prof. Arthur Barth contributed enormously to the
Danzig’s surgical traditions date back to the 15th
building and development of the – in those days
century, when the earliest hospitals were run as
– modern buildings and surgical facilities. His vast
poorhouses or shelters for the homeless. The first
surgical experience, gained at modern hospitals in
hospitals that could be compared to the hospitals of
other German cities was exploited for this purpose.
today were created at the turn of the 15th and 16th
At the same time, adapting building plans to local
centuries in the area around present-day Dyrekcyjna
conditions helped create a practical and modern,
Street (Am Olivaer Tor). Initially, it housed smallpox
hospital complex.
patients, which is why it was called a smallpox house
In 1935, based around the Municipal Hospital and the
or lazaretto. It became the actual Municipal Hospital
in the 17th century. At that time it had 15 wards and an other hospitals of the free City of Danzig, the Academy
operating room. In 1755 it acquired its own pharmacy. of Practical Medicine was opened, which in 1940 was
transformed into a full medical academy, its name later
changed to Medizinische Akademie Danzig (MAD).
In the 19th century, the Municipal Hospital treated
between 600 and 700 patients annually. It served the
Early years
city until 1911, when a modern municipal hospital
Barth was born on 20 February 1858 in Untergreißlau,
complex came into use in April of that year, later to
become a centre of academic service. It was not until near Weißenfels (state (district) of Saxony-Anhalt). His
father was a long-serving general practitioner in
the 19th century, with the city’s growing population,
Naumburg. After selling his practice, he took up
scientific development and medical advances that
farming on his family estate. It was there, too, that
three modern hospitals were built in Danzig: the
Arthur spent his carefree childhood years. He received
Hospital of Obstetrics and Gynaecology (1819), the
his primary education at home. His teachers were his
Holy Virgin Hospital (1852), and the Evangelical
governess, a primary school teacher, and his father.
Hospital run by the Deaconess Sisters (1857).
Later, from 1868 to 1870, he attended secondary
school in Weisßenfels. In 1877 he completed the
Danzig’s new Municipal Hospital complex
From 1907 to 1911 a new, 850-bed Municipal Hospital seven-year course of studies at the elite National
School in Pforta. (Figure 2)
was erected, and was officially opened in April 1911.
The facility was handed over for use, complete with
its administrative, financial and technical services. In
the early days, the surgical department and the
department of internal medicine formed the core of
the new hospital complex.
The hospital was fully capable of meeting the modern
healthcare requirements of those times. Located at
Danzig-Langfuhr, Delbrückallee (now GdanskWrzeszcz, Debinki), it had excellent connections with
the rest of the city and was easily accessible to
patients and their families.
Fig. 1: Scheme of the Municipal Hospital in Danzig
EAU History office
March/May 2013
clinic of the Augusta Hospital in Berlin (under Prof.
Ernst Küster, 1839-1930). From 1 May 1884 until 1
September 1885 he worked as an assistant in the
Department of Surgery at the Municipal Hospital in
Danzig (the Senior Registrar was Dr. Georg Wilhelm
Braun, 1836-1895). From 1885 to 1890 he was an
assistant in the Department of Surgery at Augusta
Hospital in Berlin.
When Prof. Küster was appointed Director of the
Surgical Clinic at the University of Marburg, Barth
soon followed his former Chief, and on 1 November
1890 he started work as principal assistant in the
Surgical Clinic at Marburg, becoming Deputy Head of
Department in 1891. In 1892, he qualified as Assistant
Lecturer on the strength of his paper titled “On
histological changes occurring during the treatment of
renal lesions, and behaviour of the renal parenchyma.”
His experimental-clinical dissertation based on his
activities at the University of Marburg, concerned the
assessment of treatments for kidney lesions (1892).
In 1896 he was appointed Associate Professor.
Chief of the surgery department
In 1896, Barth took over from Dr Wilhelm Baum as
director of the “old” Gdansk Municipal Hospital in
Zaspa (Sandgrube). Barth was largely instrumental in
the creation and development of the Municipal
Hospital Complex in Danzig. Among the distinguished
names involved in the establishment and
development of the modern Municipal Hospital in
Danzig was its first director, surgeon, academic and
author, Prof. Barth. He was an outstanding specialist
in osteoarticular surgery and maxillary surgery as
well as of the abdominal cavity and urology, but his
primary speciality was renal surgery.
He played a significant part in the planning and
execution of the modern Municipal Hospital complex
in Danzig. Construction began in 1907 and was
completed in 1911. Barth became director of the
Surgical Clinic in the newly-built municipal hospital
(Figure 3).
His academic works touched upon many areas of
surgery. Barth’s Magdeburg days, in the closing
decade of the 19th century, produced some of his
most highly appreciated research studies of global
significance, among other things about the artificial
production of bone tissue grafts in cases of joint
degeneration and bone transplantation.
Like many surgeons at a time when new departments
were moving away from surgical medicine, Barth
carried out urological operations and published more
than 30 outstanding works in urology. Of special
significance were his publications on subjects as
diverse as the treatment of renal lesions (doctoral
thesis), renal section, purulent kidney disease,
horseshoe kidneys, hypertrophy and atrophy of the
prostate gland, renal tuberculosis, renal abscesses
and urolithiasis, as well as his many publications
relating to other systems and disorders. These include
inflammation of the pancreas, gastric and duodenal
ulcers, cancer of the larynx, inflammation of the
paranasal sinuses, and neoplasmas of the oral cavity.
His activities as a surgeon were valued not just in
Danzig; his fame extended beyond West Prussia, and
as far as Pomerania. As a long-serving, versatile
professor of surgery he made a significant
contribution to the development of modern surgery.
He took part in World War I on Polish territory and in
France as Surgeon-General and as a consultant and
surgeon to the 17th Army Corps. He received the Iron
Cross 2nd Class and 1st Class, and in 1916 he was
awarded the noble title of “Secret Medical Adviser”
(Geheimen Medizinal-Rath).
Co-founder of the German Urological Society
Barth was a member of the German Society of
Surgeons (DGCH), and regularly attended their
congresses. He delivered many papers and was a
lively participant in discussions. He was also
co-founder of the German Urological Society (DGU) in
1907. In 1909, at the 2nd DGU Congress in Berlin, he
delivered the supplementary paper entitled:
“Suppurative, non-tubercular inflammation of the
kidneys,”.
He also took part in conventions organised by the
German Urological Society, personally delivering
urological papers. His assistants were equally
enthusiastic participants at German urological
congresses. In 1911, at the 3rd DGU Congress in
Vienna, Barth was elected fellow of the German
Urological Society.
Fig. 3: Prof. Arthur Barth, in Danzig
Barth travelled abroad, presenting papers on various
surgical and urological topics. He was a very busy
clinician and academic and published dozens of
clinical research studies and countless case reports.
Some of his published works were – and still are to
this day – often cited in Germany as well as in world
literature.
Final years
In 1924, Barth fell victim to influenza, which was
complicated by inflammation of the heart muscle.
On 1 November 1924, after spending 30 years of his
life in Danzig, at his own request, he was retired from
and went to live in Schwerin. There, he was active in
the local Medical Association and devoted his time to
writing, including writing an autobiography.
He died on 7 May 1927 in Schwerin. In accordance
with his last wishes, he was buried in Danzig in the
He was proud of his family – his wife Charlotte, the
cemetery next to the Municipal Hospital, in the
daughter of Senator Friedrich Nebelthau from Bremen Delbrückallee (now, Debinki Street). Today, the
and his five handsome and successful children.
cemetery no longer exists.
Pioneering director
His years in Danzig as hospital head were for Prof.
Barth the crowning achievement in his busy life. He
recorded successes in every area of his professional
career: academic, administrative, as well as social. He
was also both valued and respected as a top-class
surgeon by his many patients of every social standing
in Danzig and surrounding areas.
With the outbreak of World War I, his once
harmonious family life came quickly to an end. His
two sons were drafted into the army and sent off to
Fig. 2: Barth as a pupil at the classical secondary school
the front. His wife fell ill, while his son Helmut was
killed in battle. The war found him, too, serving at the
front, where he was forced to serve as a consultant
He then went on to study medicine in the medical
surgeon, employed by the German High Command.
departments at Jena, Marburg, and Berlin. He
The loss of the war and its consequences for
completed his medical studies in 1882 in Jena. That
Germany, as well as worries and concerns for the
same year he received his doctorate at Jena on the
future, took a toll on his health. In 1924, heart
strength of his dissertation titled: “On the relationship troubles, myocardial damage following influenza with
between the diameter of pelvic narrowing and the pelvic complications, finally forced him to abandon his
inlet”. He completed a one-year obstetrics course at
career as a surgeon.
the Institute of Obstetrics in Dresden and Vienna.
Scientific activity
Surgical training
Barth was an outstanding specialist in full surgery
He gained his specialisation and surgical experience
and had dozens of published works to his name on
in countless departments and clinics across Germany, that subject. He was primarily concerned with surgery
always under the guidance of eminent surgeons. In
of the genitourinary system, particularly renal and
1883-1884 he worked as a volunteer in the surgical
prostate surgery.
In 1928, Prof. Alexander von Lichtenberg in his
welcome address to the 8th Congress of the German
Urological Society in Berlin had this to say about
Barth’s death: “Prof. Arthur Barth, Surgical Senior
Registrar in Danzig, died at the age of 70. He was a
man whose brilliant work inspired many to take up
renal surgery”.
Arthur Barth was a man with many positive
characteristics: irreproachable character, a love for
everything of beauty, simplicity and humility, and a
dislike for showing off. He never put himself on a
pedestal. The words “he always proved himself a
greater man than he pretended to be” suit him
perfectly. This could be the reason why, despite his
many and great professional achievements in such
historically difficult times – Word War I and revolution
– his name has remained largely unknown. Or was it,
perhaps, because at that time Danzig was not an
academic centre of medicine?
25
Book reviews
Prof. Paul Meria
Section Editor
Paris (FR)
paul.meria@
sls.aphp.fr
Active Surveillance for
Localized Prostate Cancer
PSA-based prostate cancer detection led to a
significant increase of incidence during the past 20
years. Consequently, many indolent cancers were
discovered, with some of the cases being considered
as “overdiagnosed.”
Publication
Edition
Binding
Pages
Illustrations
Price
Website
: Nov. 2012
: 1st
: Hard cover
: 208
: 33, 22 in colour
: 148,35 euro
: www.springer.com
Klein and Jones, with the support of 50 experts, wrote
an updated and expanded third version of their
excellent textbook. They added new chapters and
dealt with some controversial aspects and new
concepts in diagnosis and treatment.
European and Canadian experiences of AS were
presented and the authors pointed out their
encouraging results and the need to perform further
studies for refining patient’s selection for AS. Diet,
physical activity and their potential benefits were also
considered such as the psycho-social aspects of
patients submitted to AS.
The authors concluded with an economical study
demonstrating a reduction of costly treatments in
patients undergoing AS and, looking to the future,
considered AS as the next standard for patients with
low-risk prostate cancer.
This excellent overview dedicated to AS fills a lack in
the literature. We can agree with the authors who
consider AS as the future standard for selected
patients. For these reasons this textbook can be
recommended to all physicians involved in prostate
cancer management.
Editor
ISBN
E-book
Publisher
: L. Klotz
: 978-1-61779-911-2
: 978-1-61779-912-9
: Humana Press
Book reviews
26
Handbook of Clinical Gender
Medicine
Gender medicine encompasses sex differences, either
genetic-biological or phenotypic, but goes beyond
these to include the broader social, cultural and
normative factors that affect health.
Male and female reproductive systems are different
but the concept of gender medicine considers the
notion that no differences exist in terms of social and
biological determinants related to health and disease.
Gender is a social science, since sex is a biological
one. The concept of gender medicine was developed
at Karolinska Institute, in Stockholm, Sweden, 12 years
ago.
An international working group was created in 2008
and obtained funding from Pfizer Inc. to support the
development of the book, which aims to change the
vision of the medical approach of gender medicine.
The introduction dealt with general considerations
about gender matters, followed by a section
addressing social and biological determinants in health
and disease. One chapter of this section focused on
ambiguous genitalia, a difficult paediatric problem.
Prostate cancer remains the most important topic in
urology based on the high number of annual
publications. Indeed, many advances were observed
during the past 10 years and a timely update remains
useful for all practitioners.
Hereditary cancers were described in detail, including
predisposing genetic factors. Recent and substantial
progresses were made in this field and the authors
The corollary was frequently a case of
reviewed various loci involved in prostate cancer
“overtreatment,” with functional consequences for the development and aggressiveness. The relation
patients and financial implication for medical care
between cancer and chronic prostate inflammation
organisations. The concept of active surveillance (AS) was discussed in a well-documented chapter.
was developed by Klotz, with the aim of limiting the
risk of overtreatment in patients with low-risk
cancers, while providing timely radical treatment for
those requiring it. Currently, this concept is supported
by an increasing number of urologists.
The key or crucial role of AS is its function to revise
the strategy in case of cancer aggressiveness, and the
authors focused on various triggers for radical
treatment; the role of multiparametric MRI in
diagnosis and monitoring was clearly demonstrated,
although the frequency of imaging remains unclear. A
special technique for PSA kinetics assessment was
also described, allowing rational decision-making.
Men’s health is a relatively recent topic strongly
related to urology. Actually, most urologists are
already involved in the management of specific
problems that impact on men’s quality of life such as
erectile disorders, ageing, lower urinary tract
symptoms or infectious diseases.
Management of Prostate
Cancer
Epidemiology and risk factors were described in a
comprehensive introductory chapter, followed by an
update on PSA and its current use. Future prospects on
blood and urinary biomarkers were described, some of
them either already available or still undergoing
further assessment. The rationale and clinical
implications of screening were described and some
recommendations were given for clinical practise.
Klotz and about 30 co-authors provided in this
textbook a comprehensive amount of updated
information about AS. After a recap on the issue of
“overdiagnosis” and “overtreatment,” the authors
focused on the selection of patients suitable for AS,
since the challenge remains on how to provide a
reliable distinction between significant and
insignificant cancers (the so-called ‘tigers and
pussycats,’ as described by Boccon Gibod in a 1996
editorial article). The authors also described tissue
and serum biomarkers and their role in predicting
high-risk disease.
Urological Men’s Health
Editor Shoskes and more than 30 co-authors aimed to
write a textbook covering the bothersome aspects of
urological conditions and their consequences on
men’s health. The opening chapter dealt with
preventive health evaluation in men, and examined
general points and non-urologic problems such as
diabetes, hypertension or immunisations.
Specific chapters covered various topics, focusing on
urogenital disorders. Erectile dysfunction was
described, including the physiologic and practical
aspects in the assessment of endothelial function.
Peyronie’s disease was also described such as the
surgical management of erectile dysfunction.
The controversies on prostate cancer screening were
discussed, focusing on PSA test and its current
usefulness. Chronic pelvic pain syndrome and
recurrent urinary tract infections, two conditions that
seriously impair quality of life, were described in
depth, including the practical aspects of their
management.
The following chapters were dedicated to various
medical specialities, including neurology, pain
management, cardiology and related topics, cancer,
rheumatisms and musculoskeletal conditions,
metabolic diseases and transsexualism. A short
section was dedicated to urology and dealt with
lower urinary tract symptoms and BPH, sexual
dysfunction in men and women, and chronic kidney
diseases.
Peculiar aspects of geriatrics were discussed in the
final section, which was dedicated to the social and
biological determinants of health in ageing people.
Undoubtedly, this original and unique textbook
collected a considerable amount of information in a
recently developed topic. It opens a new perspective
in the approach of biology and gender understanding
and serves as a guide for clinical work in various
medical specialities.
BPH and lower urinary tract symptoms, which
represent more than a third of consultations in
urology, were taken up including the medical and
surgical aspects, as well as overactive bladder and
urinary incontinence. The hormonal problems related
to male ageing were also described, with a chapter
focused on localised prostate cancer.
Other problems such as chronic pain and psychosocial
factors were discussed in the final chapters. This
textbook provides the reader with an original and
useful approach to men’s health and will be of
interest to many physicians, whether they are
urologists or general practitioners.
The role of hormones and obesity in prostate cancer
development were described and the authors focused
on chemoprevention based on dietary factors and 5
alpha-reductase inhibitors.
Editor
ISBN
E-book
Publisher
Publication
The authors pointed out the importance of prostate
Edition
biopsy procedures and described various techniques
Binding
and their respective indications. Clinical nomogrammes Pages
were considered in a special chapter, including
Illustrations
descriptions of their usefulness and current limits.
Price
Website
A richly illustrated and comprehensive chapter was
dedicated to the pathologic evaluation of prostate
cancer specimens. A substantial part of the book dealt
with the treatments of localised, locally advanced and
metastatic disease. The new concepts, such as active
surveillance, were discussed, although there are still
some remaining concerns on this topic.
A chapter focused on the management of postoperative
incontinence. The aspects of castration-resistant
cancers were considered, including secondary
hormonal therapies, cytotoxic therapies and new
developments available in the future. This textbook
presents an inclusive coverage of practical information
and can be recommended for all urologists and
oncologists, either certified or still in training.
Editors
ISBN
E-book
Publisher
Publication
Edition
Binding
Pages
Illustrations
Price
Website
: E. Klein, J.S. Jones
: 978-1-60761-258-2
: 978-1-60761-259-9
: Humana Press
: Nov. 2012
: 3rd
: Hard cover
: 428
: 37, 11 in colour
: 158,95 euro
: www.springer.com
Editors
ISBN
E-book
Publisher
Publication
Edition
Binding
Pages
Illustrations
Price
Website
: D.A. Shokes
: 978-1-61779-899-3
: 978-1-61779-900-6
: Humana Press
: 2012
: 1st
: Hard cover
: 215
: 38, 25 in colour
: 148,35 euro
: www.springer.com
: K. Schenck-Gustafsson, P.R. DeCola,
D. Pfaff, D.S. Pisetsky
: 978-3-8055-9929-0
: 987-3-8055-9930-6
: S. Karger
: 2012
: 1st
: Soft cover
: 522
: 62 fig., 4 in colour, 63 tables
: 51,00 euro
: www.karger.com
Make fewer passes,
use fewer products,
and reduce costs.
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URO-BEMEAADV-FLPEUT1-EN-201212
March/May 2013
21st Meeting of the EAU Section of
Urological Research (ESUR)
For more information please contact Congress Consultants
http://esur.uroweb.org
25-27 September 2013, Dresden, Germany
In collaboration with the 65th Congress of the DGU (Deutschen Gesellschaft für Urologie e.V.)
ESUR Board
Tentative Scientific Programme
Wednesday, 25 September 2013
ESUR Opening
Systemic therapy in metastatic RCC: Delay, start, stop?
A. Schrader, Ulm (DE)
Friday 27 September 2013
ESUR/DGU Forum: Significant prostate cancer
Prof. Z. Culig, ESUR Chairman
Prof. K. Junker, Meeting President
Mechanisms of resistance: What is different?
Role of the immune system in urology
Chemoresistance in urological tumours
Lectures by:
Lectures by:
Oral session
Oral session
ESUR poster session
ESUR/DGU poster session
Poster session ESUR/DGU
Opening DGU/ESUR
ESUR/DGU Forum: Perspectives in advanced bladder
carcinoma: From bedside to bench (ESUR/DGU)
Hot topics in urological pathology
Extended lymph node dissection in bladder cancer:
Do we have evidence for therapeutic benefit?
A. Hartmann, Regensburg (DE)
H. Moch, Zurich (CH)
G. Van Leenders, Rotterdam (NL)
T. Blankenstein, Berlin (DE)
A. Griffioen, Amsterdam (NL)
E. Nossner, Munich (DE)
Thursday, 26 September 2013
ESUR/DGU Forum: Renal cell carcinoma: Clinical
controversies and scientific perspectives
(ESUR)
Should preoperative biopsy become mandatory for all
renal tumours <3cm?
T. Steiner, Erfurt (DE)
Biomarkers for individual diagnostics and therapy:
What is possible today?
E. Oosterwijk, Nijmegen (NL)
R. Pili, Buffalo (US)
Rising PSA under hormonal treatment in M0 disease –
treat or wait?
B. Wullich, Erlangen (DE)
Sequence therapy for advanced prostate cancer
O. Cuvillier, Toulouse (FR)
B. Mellado, Barcelona (ES)
M. Puhr, Innsbruck (AT)
Translation of scientific advancement into new therapies
for prostate cancer
H. Leung, Glasgow (GB)
J. Lehman, Kiel (DE)
J. Gschwend, Munich (DE)
Mechanisms of therapy resistance
Lectures by:
Oral session
J. Catto, Sheffield (GB)
Pooled retrospective cystectomy series – reliable source
for evidence based medicine?
Z. Culig, Innsbruck (AT) - Chairman
Y. Allory, Creteil (FR)
A. Bjartell, Malmö (SE)
G. Jenster, Rotterdam (NL)
K. Junker, Homburg (DE)
M. Knowles, Leeds (GB)
M. Mancini, Padova (IT)
Faculty
T. Blankenstein, Berlin (DE)
M. Brausi, Modena (IT)
O. Cuvillier, Toulouse (FR)
A. Griffioen, Amsterdam (NL)
J. Gschwend, Munich (DE)
A. Hartmann, Regensburg (DE)
J. Lehman, Kiel (DE)
H. Leung, Glasgow (GB)
B. Mellado, Barcelona (ES)
H. Moch, Zurich (CH)
E. Nossner, Munich (DE)
C-H. Ohlmann, Homburg/Saar (DE)
E. Oosterwijk, Nijmegen (NL)
R. Pili, Buffalo (US)
M. Puhr, Innsbruck (AT)
J. Rahnenfuhrer, Dortmund (DE)
A. Schrader, Ulm (DE)
T. Steiner, Erfurt (DE)
G. Van Leenders, Rotterdam (NL)
A. Vlahou, Athens (GR)
B. Wullich, Erlangen (DE)
C-H. Ohlmann, Homburg/Saar (DE)
J. Rahnenfuhrer, Dortmund (DE)
ESOU lecture: Future therapeutic options in advanced
bladder cancer
M. Brausi, Modena (IT)
Lecture by:
A. Vlahou, Athens (GR)
ESUR poster session
European
Association
of Urology
2nd EULIS Meeting: Towards personalised management
Prof. P. Osther: “Treatment of urolithiasis is challenging, unique and rewarding at the same time”
On 5-7 September 2013, the EAU Section of Urolithiasis
(EULIS) will convene for the second time at their
dedicated meeting, this time in Copenhagen, Denmark.
After their successful pilot in 2011, the section is
compiling a very intensive and interactive programme,
featuring sessions of various formats. The EULIS
chairman, Prof. Palle Osther, answered several
questions about the upcoming meeting and the most
pressing developments in the field of urinary stones.
Palle Osther: Previously most of our knowledge on the
pathophysiology of stone formation was based on
whole urine studies, and saturation theories were the
talk-of-the-town. Recent research looks more at the
initial steps of stone formation as a microenvironmental process occurring in different parts of
the nephron, and at the meeting urinary saturation
controversially will be discussed as casual or causal in
stone disease in a pro-and-con debate.
What has changed in the field of urolithiasis since the
last EULIS meeting? Which new developments will be
addressed this time?
Furthermore, shifting trends in the endourological
management of large renal stones will be undoubtedly
heavily debated – PCNL versus flexible ureteroscopy,
conventional PCNL versus mini-PCNL, micro-PCNL,
ultra-mini PCNL. At present these minimal invasive
therapies are fighting to prove their eligibility.
Palle Osther: The incidence and prevalence of
urolithiasis are steadily increasing throughout Europe.
In the last ten years stone prevalence has increased by
30% in industrialised countries. At EULIS, we strongly
believe that increasing awareness of the kidney stone
disease is needed both from the perspective of the
doctors and the society in order to provide the best care
to this huge population of patients. This was also
reflected in the recent EAU Patient Information initiative
launched with materials on kidney and ureteral stones.
At the 2013 edition of the EULIS meeting in
Copenhagen, we will focus on trends in the field of
stone disease, both with regard to its epidemiological
aspects, basic research and pathophysiology as well
as medical and surgical management.
Surely, I am looking forward to some very interesting
and inspiring debates. These different modalities also
will be addressed in live-surgery sessions, and I am
sure this will add to our common knowledge
database on tips-and-tricks in everyday stone
management.
The programme includes a large section on stents and
the role of metal in stents – this is a very specialist topic,
how can it be of use and interest to practising
urologists?
Palle Osther: That’s right. The meeting will include a
pre-congress workshop on ureteral stenting. Recently,
For instance, we will debate why ureteroscopic
much debate has been on when to stent and when
management in some areas of Europe is now the
not to stent. On one hand the possibility to use stents
dominant treatment scenario, whereas in others SWL has been revolutionised and is now a vital part of
is still preferred for the majority of patients.
modern endourology. On the other hand, these stents
Furthermore, new knowledge on the role of Randall’s may have undesirable side-effects, such as irritative
plaques on the pathogenesis of calcium
bladder symptoms and sexual dysfunction, which
nephrolithiasis and the link between the metabolic
means that the decision of placing a stent should be
syndrome and uric acid and calcium nephrolithiasis
based on specific indications rather than as a routine
will be discussed intensively. Hopefully this will add to procedure.
our knowledge in order to provide better means for
preventing stone formation.
Different stents have been manufactured to overcome
potential side-effects, including metal stents. The
Which topics, do you expect to raise a lot of discussion– workshop will deal with overall stent issues such as
why? How are they dealt with within the programme?
indications for stent placement, durability and
March/May 2013
problems with incrustations as well the role of metal
stenting.
format of the session with the topics that need to be
covered?
Also the workshop will include live stent insertions
transmitted from the OR of Rigshospitalet in
Copenhagen. In this way the participants will get both
state-of-the-art scientific knowledge on stents in
urology as well as tips and tricks regarding placement
procedures of the different stents and on how to deal
with complications.
Palle Osther: At an international meeting on stone
disease a huge format of scientific and educational
activities are mandatory. That is why we will have a
large variety of sessions, including state-of-art
lectures, pro-and-con debates, poster-sessions,
hands-on-training courses and live surgery sessions.
Only in this way we will be able to appropriately
confront the complexity of basic research and practical
clinical management of the great varieties of stone
diseases.
At the meeting workshops on SWL, URS, PCNL as well
as medical and dietary management of kidney stones
will be offered as well. World-renowned experts from
both Europe and overseas will be conducting these
workshops, and the participants will have the
opportunity to meet urologists who have become
legends for their outstanding work in urolithiasis.
Stones are different – urinary tracts are different –
patients are different. The variability of stone disease
is tremendous. That is what makes treatment of
urolithiasis so challenging, unique and rewarding at
the same time.
There is also going to be a discussion on how to train an
academic stone doctor – why is this discussion relevant The strategy on how to manage stone disease should
and what do you expect to draw from it?
be based on a thorough individual assessment
including history, stone burden, composition and
Palle Osther: At our EULIS workshops all around the
structure, metabolic abnormalities, anatomy of
world throughout the years we have seen different
collecting system and the patient in general, patient’s
health care systems with different standards with
physical condition and co-morbidity, patient’s mental
regard to offered treatment modalities as well as
and social conditions, kidney function, bleeding
training possibilities. These events have created a
disorders and medication, symptoms and last but not
global fruitful and friendly atmosphere in the
least patient’s expectations and preferences. Also, the
urolithiasis community – we are so to speak sisters
physician’s preferences, his or her skills and
and brothers in stone.
possibilities affect treatment decision.
This very open forum allows us to take what is best
from different areas of the world, and gives us an
optimal basis for discussions on how to train an
academic stone doctor. These ties enable us to take
into consideration the best available knowledge and
local treatment opportunities, thereby creating the
foundation of evidence-based medicine in the stone
field - tracking down the best external evidence with
which to answer our clinical questions.
I strongly believe that this meeting, with all its
formats will help up on our way towards personalised
management of urolithiasis, which is the only way to
go. The event will certainly achieve what it set out to
do, help the participants to ‘bridge the gap between
basic science and clinical practice in urolithiasis’.
There is a large variety of formats at the meeting – from
workshops and state-of-the art lectures, to live surgery
and hands-on training sessions. How do you match the
Visit the official website of the EULIS meeting for
more information and to register:
http://eulis2013.uroweb.org
Abstract submission for 2nd EULIS is now open and
will close on 6 May 2013.
27
Canadian
Urological
Association (CUA)
Canadian Tour 2012
Academic Exchange Programme
CUA-EAU Academic Exchange Programme: sharing insights and best practices
Dr. A. Erdem Canda, Dr. Roman Sosnowski, Dr. Peter
Nyiradi, Prof. Rolf Ackermann
Patients sometimes would travel up to two days or
more to receive specialised care. Thus, the Internetbased ‘TeleHealth Alberta’ is a dynamic
communications system allowing multi-media
interactions between a local health facility located
somewhere and the physician based in central
Edmonton. The system enables the exchange of
crucial information regarding the patients’ health
condition and complaints, including the option for a
video transmission of the attending physician’s
examination, such as showing the malformation of
external genitalia as demonstrated in a recent case.
The Canadian Urological Association (CUA) European Association of Urology (EAU) Academic
Exchange Programme offered the opportunity to four
European urologists to visit leading urology
institutions in Canada and examine the best practices
of these institutions.
We earlier reported on the visits to Halifax and
Montreal (EUT issue Aug. 2012) and Toronto and
Vancouver (EUT issue Oct. 2012). The tour, which
further brought the participants to Calgary, Edmonton
and Banff, also allowed both European visitors and
their Canadian hosts to exchange insights on the
clinical challenges they encounter in everyday clinical
practice. The following article provides details of the
third part of the tour:
Calgary
The exciting invitation by Drs. Bryce Weber, Stephen
Pautler and Walid Farhat to participate in the 5th
Annual Course on Basic and Advanced Urology
Laparoscopic Skills in Calgary enabled us to get
practical skills in dry and wet lab training at the
Clinical Skills Building of the Faculty of Veterinary
Medicine.
Photo 4: Wet lab, Laparoscopic Urology Course, Calgary.
Picture 10: Prof. Ackermann’s speech during CUA Meeting in
During a tour conducted by Prof. Ronald Moore of the
Banff, Canada.
multidisciplinary research facilities, we realised that
the Medical Faculty and the Department of Urology at
the University of Alberta in Edmonton also pursue a
structure which allows uncomplicated interactions
among medical scientists from various disciplines. Prof.
Moore also briefed us on the exciting aspects of his
investigations in photodynamic research. A sightseeing
tour of the University of Alberta’s extensive campus
grounds gave us a view of many impressive new
buildings. Later in the day, CUA president Prof. Chetner
invited us to a wonderful dinner at the Royal Mayfair
Golf Club by Prof. Chetner, together with the members
of the department (Photo 7).
Photo 5: Downtown, City of Calgary.
Picture 11: Dr. Canda’s presentation during the Pediatric
Urology Meeting in Banff.
we enjoyed a short tour of Calgary’s downtown area,
where we saw iconic places and districts that
reminded us that the city hosted the 1988 Olympic
Winter Games (Photo 5).
Photo 1: Dry lab, Laparoscopic Urology Course, Calgary.
We very much enjoyed this special opportunity of a
practical training provided by our Canadian
colleagues and supported by highly skilled
laparoscopic urologists. The course consisted of three
parts. The first included lectures with attractive video
presentations of laparoscopic and robotic procedures,
while in the second part we had the chance to
exercise our skills using training boxes and simulators
in a dry lab (Photo 1). But the most important and
even more exciting part of the course consisted of the
hands-on training in the wet lab (Photos 2-4). We
performed laparoscopic partial nephrectomy,
pyeloplasty and nephrectomy using the latest devices,
instruments and haemostatic materials under the
enthusiastic guidance of the instructors (Photos 2-4).
Edmonton
Arriving in Edmonton on a sunny Sunday afternoon,
we all felt that we would need some physical exercise
in order to prepare for another full clinical and
scientific programme scheduled the following day. A
bicycle ride along the beautiful North Sascatchuan
River was certainly the right activity since it gave us
the first impressions of Edmonton.
Dr. Niels Jacobson welcomed us at the University of
Alberta Hospital and guided us right into the
operating room where we watched him perform a
robotic assisted radical prostatectomy, a procedure he
executed with a high level of competence. Following
the surgery, we had a meeting with Dr. Peter
Metcalfe, a paediatric urologist and third-generation
member of a very prominent family of urologists who
played a key role in developing the department
(Photo 6). We also learned from Metcalfe that
paediatric urology is further boosting its research
activities despite the clinical challenges they face.
collaboration between Canadian and European
urologists could be further intensified through
multi-institutional studies (Photo 11).
Picture 8: Dr. Howard Evans behind performing a case of
laparoscopic radical nephrectomy, Department of Urology, The
University of Alberta.
The next day’s case presentations and tour of the
outpatient facilities were followed by observing an
open radical cystectomy and subsequent urinary
diversion with ileal conduit. Later that day, we also
observed a case of laparoscopic radical nephrectomy
(Photo 8) and had the chance to visit the operating
rooms and the clinics at the Grey Nuns Community
Hospital (Photo 9).
Moreover, the course demonstrated the efforts of
Canadian urologists to further advance their already
high-level of competence. Despite a tight programme
Picture 12: Presentation of glass sculptures engraved with dates
of our visit given by Prof. Michael Chetner, President of the
CUA, Banff.
Picture 9: Dr. Keith Rourke, visiting the operating room at the
Grey Nuns Community Hospital, Edmonton.
Picture 6: Dr. Peter Metcalfe, Divison of Pediatric Urology, The
28
At CUA’s Annual Banquet, we did not only expressed
our sincere gratitude to our hosts but also took the
opportunity to present to our hosts, and on behalf of
the EAU, commemorative plates to mark this
exceptional exchange programme. We also received
from CUA president Prof. Chetner glass sculptures
engraved with the dates of our visit (Photo 12). During
the banquet Prof. Yves Fradet from Montreal received
the prestigious Award of The Canadian Urological
Association, with Prof. Lawrence Klotz giving an
impressive and very elegant introduction of Prof.
Fradet and his carreer.
Metcalfe also showed how big the area is which
covers the Yukon, the Northwest Territories and the
Hudson Bay, with its small population, and where no
local specialised medical services are available.
Picture 7: Dinner with the Faculty, Department of Urology, The
The full and insighful programme carefully prepared
by our Edmonton hosts gave us a true and realistic
insight into the comprehensive scope of their
activities. They made our stay in Edmonton not only
highly informative but also socially fulfilling. An
invitation by Prof. Gerald Todd, department chairman,
to the Faculty Club of the University of Alberta was
another highlight of the visit, and showed the
hospitality of our hosts. We left Edmonton with fond
memories, thankful for the friendliness we have
experienced.
Banff
In Banff, our last destination, we attended the 67th
Annual Meeting of the Canadian Urological
Association. Prof. Rolf Ackermann, our senior mentor,
spoke during this year’s annual conference of the
Canadian Urological Society at Banff Springs
Conference Center (Photo 10). Dr. Canda participated
at the Pediatric Urologists of Canada (PUC) that was
held during the annual CUA conference. He presented
a research project where he noted how the
The Banff meeting also gave us many opportunities to
again meet our Canadian urological colleagues who
hosted us during our visits at the Academic Urological
Institutions and Departments in Halifax, Montreal,
Toronto, Vancouver, Edmonton and Calgary. Our
thanks to all contributors from the CUA and the EAU
for giving us this excellent opportunity. And to Dr.
Keith Rourke of the Division of Urology, University of
Alberta who took us to Lake Louise, one of Banff’s
beautiful locations (Photo 13).
Picture 13: Visit to Lake Louise with Dr. Keith Rourke, Edmonton.
March/May 2013
ESUT’s dynamic presence in Milan
Well-attended live surgery sessions attest to quality content
Dr. Ioannis
Georgiopoulos
Fellow in
Endourology
Dept. of Urology
University of Patras
Patras (GR)
[email protected]
Associate Prof.
Evangelos Liatsikos
Section Editor ESUT
Patras (GR)
[email protected]
The EAU Section of Uro-Technology (ESUT) conveyed a
remarkable impression at 28th Annual EAU Congress
in Milan, by hosting a series of live surgeries,
hands-on-courses and presentations. By showcasing
the latest advances in urological technology, ESUT’s
aim was to highlight groundbreaking surgical
innovations in European urology.
For more than a decade, ESUT-sponsored live
surgeries have been among the most attended
sessions of the annual congress. Jointly organised
with EULIS (EAU Section of Urolithiasis) and ERUS
(EAU Section of Robotic Surgery in Urology), this
year’s “What is new in endourology, laparoscopy and
robotics” session, held on Saturday, April 16, was once
again very popular.
performed an innovative LESS robotic pyeloplasty,
while Prof. Stolzenburg demonstrated the use of 3D
technology in retroperitoneal laparoscopic partial
nephrectomy.
Meanwhile, Prof. Tunc (Ankara, TR) performed an
extremely rapid laparoscopic nephrectomy with a
direct upper pole access technique, which was
followed by the standard technique for robotic partial
nephrectomy expertly demonstrated by Prof. A.
Mottrie. Advanced stone surgery techniques were
then highlighted, with Prof. Traxer demonstrating his
flexible ureteroscopic management of stones in
caliceal diverticula and Dr. Breda and Giusti
collaborating to perform supine PCNL and flexible
ureteroscopy. Finally, a pre-recorded video of a
laparoscopic pudendal nerve decompression
performed by Prof. Erdogru of Istanbul was screened.
Moderated sessions
The second session moderated by Professors Artibani,
Dasgupta, Laguna and Skolarikos began with a
difficult robotic radical prostatectomy case performed
by Prof. Wiklund in a patient with advanced disease.
Professors Alcaraz and Ribal (Barcelona, ES) then
showed the possibility of NOTES nephrectomy using
3D vision through a flexible transvaginal camera. This
was followed by Greenlight PVP surgery performed by
Professors Bachmann (Basel, CH) and Tubaro (Rome,
IT). Prof. Piechaud then presented the technique for
extended robotic lymphadenectomy in prostate
cancer. The session moved on to innovations in
bladder imaging, with a presentation of Narrow Band
Imaging (NBI) and Photo Dynamic Diagnosis (PDD)
through digital cystoscopy by Prof. Malavaud
(Toulouse, FR). A novel imaging, SPIES (Storz
Professional Image Enhancement System), which
provides higher detail through modification of color
contrast was showcased by Prof. Lapini, in
combination with PDD for a bipolar-resection of
bladder tumours.
Hands-on laparoscopy course
These courses are always very popular and, since
space is limited, are often sold-out even before the
start of the congress.
A variety of courses in minimally invasive surgical
techniques was available again this year and eagerly
awaited by participants. Basic laparoscopic courses
were offered, with experienced tutors demonstrating
basic techniques in pelvi-trainers. More advanced
laparoscopic surgeons could take courses in LESS
techniques, where the details of single-site surgery
were explored in greater depth. For the endoscopic
treatment of BPH, a course on bipolar TURP was
presented, and trainees refined their skills using a
simulator in complex cases.
Greenlight prostate vaporization courses were also
available, and participants can choose either basic or
advanced skills lessons. A virtual reality model
replicated the surgical experience for trainees, and
sessions were enriched with surgical videos and tips
from the expert tutors. For the management of
urolithiasis, courses in endourology and
ureterorenoscopy were available. Trainees also had
the opportunity to become familiar with the wide
range of equipment used (baskets, wires, lasers, etc),
and to perform flexible ureteroscopy and lithotripsy in
models. A course in robotic surgery was also offered,
and reservations were needed due to very limited
slots. The course took trainees through the basics of
robotic surgery, from the efficient use of the console,
drills for improving hand-eye coordination to
finishing the standard steps of robotic surgery.
Members of the ESUT were also actively involved in
ESU courses and presentations. These two to
three-hour long courses are a great opportunity for
participants to become acquainted with specific
details of a technique or the management of a specific
entity. ESUT members were responsible for some of
the more popular courses, including a flexible
ureterorenoscopy course by Prof. Traxer, a PCNL
course by Professors Liatsikos and Knoll, a robotic
prostatectomy course by Prof. Piechaud and a NOTES
and mini-laparoscopy course by Prof. Rane. More
advanced surgeons had the opportunity to participate
in the laparoscopic and robotic cystectomy course
with Professors Rassweiler and Van Velthoven.
In summary, ESUT’s participation in this year’s annual
EAU congress focused on the exciting developments in
uro-technology. We look forward to next year’s congress
in Stockholm for us to provide another opportunity to
bring the future of urology closer to the present.
Upcoming ESUT affiliated events
The third and final surgical session included an
interesting mix of upper and lower tract techniques,
and was moderated by Professors. De la Rosette,
Michel, Burchardt and Annerstedt. A quick and
practical BPH treatment, Urolift, was demonstrated by
Professors Sievert and Woo, with the case completed
in 10 minutes. In other BPH cases, Prof. Carmignani
(Milan, IT) performed a TULEP technique, while Prof.
Pfitzenmaier (Bielefeld, DE) performed a prostate
vaporisation.
Live surgery session
The audience was treated to the best in current
surgical techniques by internationally renowned
experts, and had the opportunity to participate in a
lively debate with the surgeons and moderators. The
session began with an introduction by ESUT Chairman
Prof. J. Rassweiler who noted the close collaboration
among the participating surgeons and the
outstanding facilities of the Department of Urology at
San Raffaele Turro Hospital, and at the Vita Salute San
Raffaele University. Dr. Andras Hoznek then presented
follow-up details on last year’s live surgery patients,
in accordance with the new EAU policy on surgical
ethics in live surgery. This critically important
innovation was reviewed by Prof. Artibani, in advance
of Prof. Keith Parson’s full presentation of the new
policy during the final plenary session.
Prof. Liatsikos (Patras, GR) then demonstrated his
technique for single-site laparoscopic nephrectomy
using 3D vision assistance. Near the end of the
session, two interesting pre-recorded videos were
shown, with a novel robotic-assisted flexible
ureteroscopic system presented by Prof. Saglam
(Ankara, TR) and Prof. Janetschek’s video of a pelvic
lymphadenectomy assisted by ICG (Indocyanine Green
dye). Concluding the very successful meeting, closing
remarks were given by Prof. van Velthoven.
World Congress of Endourology 2013
in New Orleans, USA
The Society of Endourology is the premier
organisation whose aim is to share, teach, and report
the latest state-of-the-art developments in
endourology, laparoscopy, robotics, percutaneous
surgery and minimally invasive surgery.
For the 31st Annual World Congress of Endourology &
SWL (WCE) scheduled on October 22 to 26, 2013 in
New Orleans, our scientific theme will focus on
state-of-the-art advances in biomedical imaging for
pre-surgical planning, intraoperative navigation and
improvement of outcomes. International experts in
this exciting and innovative field will cover emerging
technologies on image-guided surgery such as:
Moderated by Professors Rassweiler, Abbou, Wiklund
and Knoll, the initial surgical session began with
interventions in the upper urinary tract, with the
procedures transmitted via the massive screens of the
eURO auditorium. Prof. Guazzoni (Milan, IT)
• Molecular Imaging to Decrease Positive Surgical
Margins;
• Nanotechnology and Urology;
• Optical Biopsy of Urothelial Carcinoma Using
Confocal Endomicroscopy;
• Image fusion of MR and Ultrasound for Prostate
Biopsy;
• Critical Analysis of Focal Therapies for Prostate
Cancer; and
• Other specialty lectures from world-renowned
speakers
Hands-on ureteroscopy course
Visit our website
(www.wce2013.com) for further information
Members of the audience use 3D glasses in some live surgery
sessions
EAU Section of Uro-Technology
March/May 2013
An important aspect of ESUT’s efforts in promoting
technological advances is the education and training
of younger urologists. ESUT (in collaboration with
EULIS and ERUS) actively participates in hands-oncourses organised by the European School of Urology.
Instructional courses
WCE2013 will also feature an expanded number of
morning instructional courses, featuring international
experts sharing their experiences, tips and tricks,
management of complications including:
• Practical Management of Stones: Prophylaxis &
Medical Management
• BPH and Incontinence
• Ablation of Small Renal Mass: Current Status
• Management of Complications After Laparoscopy &
Robotics
• Robotic Prostatectomy: Step-by-Step Technique
• Endourological Treatment of Upper Urinary Tract
Tumor
• Stents: What’s New
• Percutaneous Surgery: Supine and Prone
Approaches, Access Technique (Fluoroscopy vs.
Ultrasound)
• Imaging and Uro-Radiology
• Robotic/Lap Partial Nephrectomy
• NOTES & LESS in Urology: What Can We Do Now?
• Robotic Assistant: Help Me, Don’t Hurt Me
• Ureteroscopy: Rigid and Flexible Techniques
Submit your abstracts for WCE 2013
The abstract submission site is now open. The
Make plans now to join us October 22 - 26, 2013, in
deadline for poster and video abstracts is June 3, 2013. New Orleans, Louisiana, for WCE2013. We look
forward to seeing you there!
Submit your abstracts now at www.wce2013.com!
29
Congress calendar 2013/2014
May
15-16: Cambridge, United Kingdom
Flexible and rigid ureteroscopy workshop
Contact: Stephanie Taylor
E-mail:[email protected]
Website:www.camurology.org.uk
15-18: Bucharest, Romania
National Congress of the Romanian Association of
Urology
Contact: Dr Radu Constantiniu
17: ESU organised course on Place and role of
lymphadenectomy in urologic cancers at the time of
the national congress of the Romanian Association
of Urology
Contact:ESU
16-17: Cambridge, United Kingdom
International Multidisciplinary workshop on
Prostate Multiparametric MRI Reading (ESU) &
MRI-targeted Transperinal Prostate Biopsies
Contact: Stephanie Taylor
Website:http://www.camurology.org.uk/
teaching/courses/prostatemultiparametric-mri-reading-andmri-targeted-transperineal-prostatebiospsies-may-2013/
16-17: Athens, Greece
Prostate Cancer Translational Research Conference
Contact: Prostate Cancer 2013 Secretariat
Website:http://www.prostatecancer2013.com
16-18: Osijek, Croatia
Symposium 10th Osijek Urological Days and 3rd
Osijek Nephrology Days
Contact: Dr. Hrvoje Kuveždic
Website:www.urologija.kbco.hr
17-19: Athens, Greece
33rd Athenian Urology Days
Contact: ERASMUS S.A.
Website:www.athenianurologydays.gr
18-21: Istanbul, Turkey
50th ERA-EDTA Congress
Contact: ERA-EDTA Congress Office
Website:http://www.era-edta2013.org/
19-23: Milan, Italy
Symposium on biomarkers of prostate cancer
Contact: Dr Cathie Sturgeon
Website:www.milan2013.org/index.php
24-25: Jastrzebia Góra, Poland
6th Pomeranian Uro-Oncology Conference
Contact: Elzbieta Senkus-Konefka - Medical
University of Gdansk
Website:www.uro-onko.pl
28-1 Jun: Dublin, Ireland
38th Annual Meeting of the International
Urogynecological Association
Contact: IUGA Office
Website:http://www.iuga.org/
29-31: Amsterdam-Noordwijk, The
Netherlands
6th International Symposium on Focal Therapy and
Imaging in Prostate & Kidney Cancer
Contact: ERASMUS SA
Website:www.focaltherapy.org
30-31: Lisbon, Portugal
14th Practical Course Prostate Ultrasound and
Biopsy - 5th International Workshop on Prostate
Biopsy
Contact: Ana Pais
Website:http://www.admedic.pt/ficheiros/
congressos/programa1362148778.pdf
30
30-1 Jun: Amsterdam, The Netherlands
1st World Congress on Abdominal and Pelvic Pain
Contact:CongresLink
Website:www.pelvicpain-meeting.com
31: Tartu, Estonia
8th Baltic Urological Conference
Contact: Estonian Society of Urologists
31: ESU organised course on Pushing back the
boundaries in CRPC and UTI at the time of the
national congress of the Estonian Urological
Association
Contact:ESU
31-4 Jun: Hong Kong, China
World Congress of Nephrology ISN, HKSN and APSN
Contact:ISN
Website:http://www.wcn2013.org/
31-4 Jun: Chicago (IL), USA
Annual Meeting of the American Society of Clinical
Oncology (ASCO)
Website:http://events.jspargo.com/asco13/public/
enter.aspx
June
4-5: London, United Kingdom
Advanced Applied Female Pelvic Anatomy and
Surgery (Cadaveric course)
Contact: RCS Education
Website: http://www.rcseng.ac.uk/courses/coursesearch/course.2007-05-31.6426708897
4-5: Bristol, United Kingdom
2nd Young Urology Meeting
Contact: Young Urology Meeting
Website:www.young-urology.org
5-8: Murnau, Germany
26th Annual Meeting of the German-speaking
medical Society for Paraplegia (DMGP) 2013
Contact: Conventus Congressmanagement &
Marketing GmbH
Website:www.dmgp-kongress.de
6-7: Tirol, Austria
Minimally Invasive Percutaneous Stone Therapy
Clinical Workshop (MIP)
Contact: Dept. of Urology and Andrology
6-8: Lisbon, Portugal
6th EAU Leading Lights in Urology (LLU) followed by
the Young Academic
Urologists Meeting (YAUM)
Contact:EAU
Website:http://leadinglights.uroweb.org/
6-8: Cologne, Germany
Brachytherapy for Prostate Cancer Course
Contact:ESTRO
Website:http://www.estro-events.org/Pages/
defaulthome.aspx
7-8: Paris, France
Third Teaching Course on Prostate MRI
Contact: F. Cornud, D. Portalez
Website:www.prostatemricourse.com
7-9: Ankara, Turkey
2nd Ankara Robotic Urology Symposium & Course
Contact: A. Erdem Canda, MD
Website:www.robotictimes.org
12-14: Trnava, Slovakia
20th Annual Conference of the Slovak Society of
Urology
Contact: Tatiana Ivancikova, Tajpan s.r.o.
Worldwide, continually updated urological meeting calendar at
13: ESU organised course on Interventional
therapy for BPO - Surgical treatment for BPO at
the time of the national congress of the Slovak
Urological Association
Contact:ESU
12-14: Marseille, France
Global Congress on Prostate Cancer 2013
Contact:e-hims
Website:www.e-hims.com
14-16: Izmir, Turkey
1st International Uroanatomy Congress
Contact: International Young Urologists
Association (IYUA)
Website:www.uroanatomy.org
17-20: Manchester, United Kingdom
Annual Meeting of The British Association of
Urological Surgeons (BAUS)
Contact:BAUS
Website:www.baus.org.uk
21-22: Minsk, Belarus
National congress of the Belarussian Association of
Urology
Contact: Prof. Viachaslau Vshchula
22: ESU organised course at the time of the
national congress of the Belarussian Association of
Urology
Contact:ESU
6th Hamlyn Symposium on Medical Robotics
Contact: The Hamlyn Centre
Website:www.hamlyn-robotics.org/
22-25: Niagara Falls (ON), Canada
68th Annual meeting of the Canadian Urological
Association
Contact:CUA
Website:www.cua.org/
26-28: Paris, France
3rd International Meeting “Challenges in
Endourology and Functional Urology”
Contact: ERASMUS SA
Website:www.challenges-endourology.com
26-28: Malmö, Sweden
Prostate Cancer Translation Research in Europe
(PCTRE)
Contact: Congress Consultants
Email:[email protected]
Website:http://pctre2013.uroweb.org
July
5-6: Athens, Greece
Clinical Topics in Urology “Lithiasis from A TO Z”
Contact: ERASMUS S.A.
Website:www.CTUcongress.org
4-5: Tirol, Austria
www.uroweb.org
August
6-10: Melbourne, Australia
Prostate Cancer World Congress
Website:www.prostatecancercongress.org.au
26-30: Barcelona, Spain
Annual Meeting of the International Continence
Society
Contact: ICS Office
Web:http://www.icsoffice.org/Events/
ViewEvent.aspx?EventID=180
September
3-5: Stockholm, Sweden
ERUS’13 - EAU Robotic Urology Section Congress on
Latest Developments in Robotic Surgery
Contact: e-HIMS bvba
Website:www.erus2013.com
5-7: Copenhagen, Denmark
2nd Meeting of the EAU Section of Urolithiasis
(EULIS)
Contact: Congress Consultants B.V.
Website:http://eulis.uroweb.org
5-7: Jachranka, Poland
43rd National Congress of the Polish Urological
Association
Contact: PTU E-Mail:[email protected]
Web:www.pturol.org.pl
6: ESU organised course Update in non-muscle
invasive bladder cancer T1G3 and nephron sparing
surgery at the time of the 43rd National Congress of
the Polish Urological Association
Contact:ESU
8-12: Vancouver, Canada
33rd Congress of the Société Internationale
d’Urologie (SIU)
Contact: SIU Central Office
Website:www.siu-urology.org/
10: Birmingham, United Kingdom
Dragon’s Den’ Urology SaPhonelite Meeting,
“New Horizons in Non-invasive bladder cancer”
Contact: Centre for Professional Development
Website:http://www.birmingham.ac.uk/facilities/
mds-cpd/conferences/urological-cancertrends/saPhonelite-meeting/
saPhonelite-meeting.aspx
11: Birmingham, United Kingdom
Current Trends in Urological Cancer, 10th Annual
Symposium
Contact: Centre for Professional Development
Website:http://www.birmingham.ac.uk/facilities/
mds-cpd/conferences/urological-cancertrends/index.aspx
12-13: Tirol, Austria
ESU - Weill Cornell Masterclass in General urology
Contact:ESU
Website:http://esusalzburg.uroweb.org
3rd Joint Meeting of the EAU Section of GenitoUrinary Reconstructive Surgeons (ESGURS) and the
EAU Section of Andrological Urology (ESAU)
Contact: Congress Consultants B.V. E-mail:[email protected]
Website:http://esgurs-esau.uroweb.org/
12-13: Beijing, China
13-18: Prague, Czech Republic
Chinese Urology Education Programme (CUEP)
Contact: European School of Urology (ESU) and
Chinese School of Urology (CSU)
Website:www.uroweb.org
11th European Urology Residents Education
Programme (EUREP)
Website:http://eurep.uroweb.org/
7-13: Salzburg, Austria
March/May 2013
Congress calendar 2013/2014
Worldwide, continually updated urological meeting calendar at
19-22: Istanbul, Turkey
6-8: Moscow, Russia
20th European Symposium on Urogenital Radiology
(ESUR 2013)
Contact: Organization Secretariat
Website:http://www.esur2013.org/en/default.asp
20th Annual meeting of the Chinese Urological
Association (CUA 2013)
Contact: Ms. Betty Zhou
Website:www.cuan.cn
National Congress of the Russian Society of Urology
Contact:[email protected]
23-27: Countries all over Europe
Urology Week 2013
Contact: European Association of Urology
Website:www.urologyweek.org
25-27: Dresden, Germany
21st Meeting of the EAU Section of Urological
Research (ESUR)
In collaboration with the 65th DGU Congress
Website:http://esur.uroweb.org
25-28: Dresden, Germany
65th Congress of der German Society of Urology
(DGU)
Contact:DGU
Website:www.dgu-kongress.de/index.
php?id=571&L=2
26-27: Amsterdam, The Netherlands
2nd International State-of-the-Art in Uro-Oncology
Conference on Prostate and Kidney Cancers
Contact:EUOG
Website:http://euog.org/
27-1 Oct.: Amsterdam, The Netherlands
17th ECCO - 38th ESMO - 32nd ESTRO European
Cancer Congress
Contact:ECCO
Website:http://www.ecco-org.eu
Understanding Urodynamics Course
Contact: Royal College of Obstetricians and
Gynaecologists
Website:http://www.rcog.org.uk/events/
understanding-urodynamics-0
October
2-4: Moscow, Russia
VIII Congress of the Russian Association of
Oncological Urology
Contact: Kamolov Bakhodur
Website:www.roou.ru
2-5: Lima, Peru
Congreso CAU Peru 2013
Contact: Sociedad Peruana de Urología
Website:www.cauperu2013.com/
13th Central European Meeting (CEM)
Contact: Congress Consultants B.V
Website:http://cem.uroweb.org
5-8: Riccione, Italy
86th Annual Meeting of the Società Italiana di
Urologia (SIU)
Contact: Società Italiana di Urologia (SIU)
Website:www.siu.it
10-12: Tübingen, Germany
1st Joint Section Meeting of Female and Functional
Urology (ESFFU), Genito-Urinary Reconstructive
Surgeons (ESGURS) and Oncological Urology (ESOU)
E-mail: [email protected]
Website:http://esffu-esgurs-esou.uroweb.org
CUA-EAU Programme on LUTS and Oncology
Contact: European School of Urology (ESU) and
Chinese School of Urology (CSU)
March/May 2013
Annual Scientific Update in Urogynaecology
Contact: Royal College of Obstetricians and
Gynaecologists
Website:http://www.rcog.org.uk/events/annualscientific-update-urogynaecology-0
16-19: Umag, Croatia
5th Congress of the Croatian Society of Urology with
International Participation
Contact: Jelena Krmic
Website:www.5hrvatskikongresHUD2013.org
22-26: New Orleans (LA), USA
31st World Congress of Endourology and SWL
Contact: Endourological Society
Website:www.wce2013.com
24-26: Eger, Hungary
National congress of the Hungarian Association
Urology
Contact: Dr. Tóth György
26: ESU organised course on Prostate cancer at
the time of the national congress of the Hungarian
Association Urology
Contact:ESU
30-1 Nov: Carlsbad, Czech Republic
National congress of the Czech Urological Society
Contact: Dr. Milan Hora
31: ESU organised course on Female urology;
fundamentals of stress incontinence and prolapse
at the time of the national congress of the Czech
Urological Society
Contact:ESU
30-3 Nov.: Antalya, Turkey
National Congress of the Turkish Association of
Urology
Contact:TAU
Website:www.uroturk.org.tr
1: ESU organised course on Localised prostate
cancer at the time of the national congress of the
Turkish Urological Association
Contact:ESU
31-2 Nov: Amman, Jordan
8th international conference of the Jordanian
Association of Urological Surgeons (JAUS)
Contact: Dr. Khaldoun Gharaibeh
E-Mail:[email protected]
31: ESU organised course at the time of the
national congress of the Jordanian Association of
Urological Surgeons
Contact:ESU
November
1-3: Thessaloniki, Greece
9th South Eastern European Meeting (SEEM)
Website:http://seem.uroweb.org/
4: Tashkent, Uzbekistan
National congress of the Scientific Society of
Urologists of Uzbekistan
Contact:SSUU
4: ESU organised course on Updates on urooncology
at the time of the national congress of the Scientific
Society of Urologists of Uzbekistan
Contact:ESU
7: ESU organised course on Update and evolving
investigation in urology at the time of the national
congress of the Russian Society of Urology
Contact:ESU
6-10: Antalya, Turkey
11th Urooncology Congress
Contact: Association of Urooncology, Turkey
Contact: Serenas Tourism Congress Organization Co.
E-mail: [email protected] [email protected]
Website:www.urooncologycongress.org
8-9: Strasbourg, France
Annual symposium Robotic Assisted Microsurgical
& Endoscopic Society (RAMSES)
Contact:RAMSES
Website:WWW.ROBOTICMICROSURGEONS.ORG
15-17: Marseille, France
5th Multidisciplinary Meeting on Urological Cancers
Embracing Excellence in Prostate, Bladder and
Kidney Cancer
Contact: EAU, ESMO and ESTRO
Website:www.emuc2013.org
14: ESU Medical oncology course on Genitourinary
Cancer (MOGUC)
Contact:ESU
15-17: Berlin, Germany
6th ESU Masterclass on Female and functional
reconstructive urology, in collaboration with the
EAU Section of Female and Functional Urology
(ESFFU)
Contact:ESU
20-23: Paris, France
107th National Congress of the French Association
of Urology
Contact: Colloquium-AFU 2013
Website:http://www.urofrance.org/congres-etformations.html
22: ESU organised course on Lasers and
endoscopes in urology: “What an urologist should
know” at the time of the national congress of the
French Association of Urology
Contact:ESU
21-22: Tirol, Austria
Clinical Workshop Program 2013 - Laparoscopic
Partial Nephrectomy & Single Incision Triangular
Umbilical Surgery
29: Kazan, Russia
Conference of the Russian Association of
Oncological Urology in the Volga federal district
Contact: Russian Association of Oncological
Urology
Website:www.roou.ru
www.uroweb.org
January 2014
11th Meeting of the EAU Section of Oncological
Urology (ESOU)
Website:http://esou.uroweb.org
February 2014
1-4: Davos, Switzerland
European Urology Forum 2014 - Challenge the
experts
Contact:ESU
April 2013
11-15: Stockholm, Sweden
Website:www.eaustockholm2014.org
May 2013
30-3 June: Chicago, USA
American Society of Clinical Oncology (ASCO)
Annual Meeting 2014
Contact:ASCO
Website:www.asco.org/portal/site/ascov2
June 2013
21-24: St. Johns (NL), Canada
69th Annual meeting of the Canadian Urological
Association
Contact:CUA
Website:www.cua.org/
October 2013
1-4: Dusseldorf, Germany
66th Congress of der German Society of Urology
(DGU)
Contact:DGU
Website:www.dgu.de/
12-16: Glasgow, Scotland
34th Congress of the Société Internationale
d’Urologie (SIU)
Contact: SIU Central Office
Website:www.siu-urology.org/
December 2013
5-9: Kish Island, Iran
12th Asian Congress of Urology (ACU)
Contact: Urological Association of Asia and
Iranian Urological Association
Website:www.12thacu2014.org
December
2-6: Sharm el-Sheikh, Egypt
National congress of the Egyptian Association of
Urology
Contact: Prof. Eissa - EUA President
4: ESU organised course on paediatric urology for
the adult urologist: A practical update at the time
of the national congress of the Egyptian Association
of Urology
Contact:ESU
6-7: Tirol, Austria
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
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
31
Who’s Who in Urology
Notification:
Promoting
your
meetings
The EAU executive is
pleased to help promote
any scientific meetings.
However, due to the large
number of requests we
are receiving, we have
been forced to set up
some rules and
regulations related to
the circulation of
promotional material.
Jan Breza
Gabriel Haas
Raja Khauli
Chairman, Department of Urology, Slovak Medical
University Bratislava, Slovakia; Professor and
Chairman, Department of Urology, Comenius
University School of Medicine, Bratislava; ViceChancellor (2003-2010); Slovak Medical University;
Visiting Associate Professor (1991-1993), Department
of Urology, University of California, San Francisco,
USA; Awarded, Frans Debruyne Lifetime Achievement,
EAU (2013); Honorary Member (2009), European
Association of Urology; Awarded (2008) Jessenius
Award, Slovak Academy of Science; Awarded (2003)
Slovak Medical Association – Gold Medal; Author of
more than 190 international medical publications.
Medical Director (2009-Present) of Urology, Astellas
Global Development; Professor and Chairman
(1995-2007), Department of Urology at SUNY Upstate
Medical University, Syracuse, New York, USA;
Honorary Member, Peruvian and Hungarian
Urological Associations. Former President, Hungarian
Medical Association of America and of the
Northeastern Section of the American Urological
Association; Author of over 170 scientific papers and
book chapters; Former Editor, Canadian Journal of
Urology.
Professor of Surgery, and Head, Division of Urology,
American University of Beirut Medical Center; Adjunct
Professor of Urology, University of Massachusetts
Medical Center, Worcester, Massachusetts, USA;
Residency in urology, University of Maryland and the
Cleveland Clinic Foundation; Elected President (2006),
Arab Association of Urology; Chairman (2012)
Examination Committee of the Arab Board of Urology;
Member (2013), EAU Regional Board; Elected
President, Urological Society for Transplantation and
Renal Surgery (USTRS); Author of more 160 peer
reviewed manuscripts and 11 book chapters.
Europe
Official
9
newsletter
Adolesc
ent
an Uro
log
of the
European
urology
Special
needs of
creation
adolescen
of
ts
a stronger
require
Prof. Jean-Jacque
the
adolescen
s Wyndaele
t urology
Associatio
27th An
31
nual EA
Sustained
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research
work
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Active
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A word
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of
low-risk
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patient
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the risk
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of overdiagn
Bangma
osis
y Toda
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Vol. 24
Prof. Chris
No.2 -
March/May
9th ESOU
35
2012
800 participanMeeting
ts gather
on latest
in Hamburg
developm
ents in urologica for update
l cancers
Further
investmen
and urology’s
ts in innovative
colleague
s
stronger
discipline
said Prof. and specialists
ties with research studies
s
from other
Hidehiro
other medical
that was remain one of
Japanese
Kakizaki
discipline
the key,
reiterated
Urologica
who
s,”
overarchi
five-day
l Associatio co-chaired the
ng themes Chris Chapple.
27th Annualby opinion leaders
n session
This year
February
returned
throughou
EAU Congress
the Japanese with Prof.
24 to 28
t the nearly in full force
held from
in Paris,
France.
a year after with more than delegation
Experts
prevented
the Fukushim
150 participan
who
strategies lectured and
Vienna. many from attending a calamity which ts,
spoke
during the
the 2011
significant
congress on optimal treatment
congress
were one
in
managem gains made in
The
in
reporting
saying
medical
ent in recent
that ICUD-EAU
and
sessions
healthcar
of the Committe
e if innovative years can only surgical
closely working
lead to better
(5th ICI) International Consultati
es of the
studies
held in the
and the
with other
pursued.
on on
first two
specialists crucial role of the need for a
days also Incontinence
balanced
are consistent
fields such
demonstr
approach
the rising
ated
ly related
“This annual
in other
urologica
Lower Urinaryincidence of
congress
together
incontinen
l
the most
Tract Symptom
and pursuing provides evidence
ce and
highly attended
research
session
the goals
that
for
meetings, s (LUTS). One of
of groundbr working expert collated the
treatment insights that will
the reporting
eaking
groups on consensus findings
for patients
help us
the strong
identify
is only
of various
effective imaging, fistulas, a range of issues
General links we now have,”possible if we
from epidemio
pharmaco
syndrome
maintain
Per-Ande
logy to bladder
, among
logy,
rs Abrahams said EAU Secretary
ceremony
other incontinen
.
pain
son during
ce topics.
the opening Focus on uro-onco
With eight
logy
plus the EAU Section Meetings
Profs. Radziszews
first plenary
held on
ki and Chapple
cancer, participan
session
which tackledFebruary 25
(3rd and
ts had a
variety of
4th from
bladder
full-day
specialise
left) chair
agenda
transmiss
the second
d topics
and a wide Atala as he
ions
to choose
plenary
rooms located of surgeries
session
complex listed various obstacles
on functional
conducted from. Live
work involved
were presentedin Paris, Aalst
urology
in
scaffolds,
in creating such as the
(BE) and six operating
avoiding
by
(ESUT),
biological
tumour
all-cause
a feat that the EAU Section Mannheim (DE) construction
formation
and prostate
of stable
of Uro-Techn
previous
exceeded
added: “Surgery
blood vessels. and the
congresse
ESUT’s
cancer mortality,
in cooperati
s. The day-long programm ology The last-day
did not
observatio
” said Wilt.
es in
reduce
plenary
session,
presented on with the ERUS,
He
cancer. A n in men with low mortality more
session
conducted developments
examined
potential
PSA or
than
bladder complex surgical EULIS and ESIU,
Prof. Freddie in prostate
exist in
the latest
and kidney
procedure
men with mortality benefi low risk prostate
Hamdy givingcancer (PCa) research.
surgeries.
s in prostate,
personali
t from
higher PSA
disease.”
sed
the keynote
With
and possibly surgery may
At the plenary
PCa, Professortreatment for
remarks
high risk
session
s Timothy low and intermedi on
Professor
provided
on managing
The concludin
s
Wilt
updates
ate
in-depth Manfred Wirth
bladder
g part of
PCa, respective on the PIVOTand Lars Holmberg risk late-break
and
cancer
discussion
the last
ing
and SPCG4
ly.
either medical
s, highlightiJames Catto led
Mason and developments session focused
studies
ng the
or surgical
on
Fritz Schröder with Professor
on neoadjuva
the extent
approach suitability of
s Malcolm
updating
es (dependin
patient’s and aggressiveness
the audience
screening nt hormone therapy
response
of the disease)
g on
data, respective
have seen
and prostate
to the selected
on
ly.
cancer
treatment and
quality of an improvement
Key
. “We
in
life,”
messages
on the benefi said Prof. Arnulftechnique, capacity
• Degarelix from Mason
ts of cystectom
and
Stenzl
and Schröder
standard
is
goserelin ‘non-inferior’
despite
y, considerein his lecture
were:
the emergenc
therapies
plus bicalutam to the combinat
d
volume
.
e of newer as the gold
ide at reducing ion of
in patients
medical
dependen
with
prostate
Catto noted
t PCa (Mason). advanced hormoneLive transmissio
issues, a the critique on
• The Phase
fact
radical surgery
ns of prostate,
conducted
that chemo-raunderscored
111b CS30
bladder
in
due
offered
by
and kidney
organised 6 operating rooms
better control trial revealed
of patients, diation offers Nicholas James to QoL
surgeries
by ESUT
that degarelix
symptoms
who said
benefits
of lower
in cooperationin 3 different countries,
deserves and pointed out
to certain
Session
urinary
hesitancy (LUTS) such as
with EULIS,
were
a re-evalua
participant
that
types
frequency tract
in urination.
ERUS and
s view the
3D glasses
tion in the bladder-preservatio
, urgency
ESIU
ESUT live
(Mason).
light of
Right on
and
The need
surgeries
recent data. n
• The two-year
the first
with
for sustained
day,
the EAU
theme in
with 11 other the joint meetings
21% reductionupdate on the
the second research efforts
associatio
urology
ESRPC study
regional
organised
ns
with Profs. plenary session was a recurring “In men with
of 1% comparedon PCa mortality
by underlinin
showed
programm for the Urology and internatio
on
Chapple
during the localised prostate
a
rate, or
nal
with the
Beyond
(Schröder
and Piotr functional
g
an increase
consultati e demonstrated
Europe
interim
identifying the crucial role
); and
Radziszew
compared early PSA era, radical cancer detected
study of
the
on
researche
to observatio
2009
Particular among various need for closer
prostatect
treatment the most effective
rs can play ski
• Early
ly
urology
n did not
.
omy
PCa diagnosis
and medicalin uro-oncology
groups.
emerging Prof. Karl-Dietrich medical or surgical in
significantly
where
the known
prospects
treatment
has defi
Sievert examined
reduce
cancers
newer options
nite benefi
, saying
for prostate new diagnostic
are
overdiagn disadvantages,
in pharmaco that current trends
countries emerging, practition and kidney
current
osis (Schröder such as a ts, alongside
such as
use
high rate
therapy
ers from
).
Japan,
Latin-Ame
aside from point to
On biomarkeof antimuscarinics
of
diverse
rican countries,Iran, India,
the
and
r
research,
vital to maintain
the Arab
PDE-5
outcomes
to name
and
in the coming Sievert expects inhibitors.
effective
a
and outside
more
collaborat few, said it is
years as
urology.
new data concrete
ive work
Technolog
within
come in.
ical
“Our participat
New technologadvances
ion here
y
learning
and
were
reflects
the attendant
discussed
from
the importan
if we expand each other.
in the fourth-da myriad
topics such
our views We can only move t role of
y plenary challenges
nephrolith as the optimal
to consider
session
forward
use
those of
ureterend otomy, new optical of percutaneous with
our
oscopy,
systems
benefits
and the
in
use
of
AUA lecture of simulation shock wave lithotripsy
on regenerat in surgical training.
Anthony
Atala, director ive medicine
The
Regenera
tive Medicine, of the Wake given by Prof.
in tissue
showcase Forest Institute
engineeri
for
cells to create
ng, particular d the current
efforts
ly the use
biological
kidney,
of stem
substitute
heart, liver
s for the
and many
other organs. bladder,
“There are
March/Ma
still challenge
y 2012
resolve
s
several
issues in ahead…we still
tissue engineeri need to
ng,” said
and mult
i-dis
By Joel Vega
s: Collab
ciplinary
orative
work is
crucial
links are
essential
, say opin
ion
28th Ann
www.eaum ual EAU
ilan2013.org
Congres
leaders
s
Europea
n Urology
Today
1
All EAU related meetings (Section Offices
either full members or partners) and national
societies meetings with which we have a
special alliance, may be promoted by e-mail
(e-mail newsletter or separate e-mail
communication), in addition to the other
available channels.
All other urological meetings may be
included in our Uroweb and Urosource
congress calendar as well as in the European
Urology Today congress calendar.
Please feel free to contact us
([email protected]) in case there are any
queries or remarks related to this notice.
“Who’s Who in Urology,” is an informative listing of decision-makers, leading researchers, faculty heads, industry representatives, medical scientists and
other active professionals in urology. This series reflect not only the milestones achieved in urology but also show urology’s multifaceted network and
interdisciplinary nature.
Win a free registration to Stockholm in 2014!
EU-ACME members, join the MCQ quiz published in European Urology
To increase awareness regarding the significant and
growing role of online Continuing Medical Education
(CME) and promote its benefits, the EU-ACME office
introduced in 2009 an exciting initiative amongst its
members.
From all EU-ACME members who participated, the
three highest scoring participants who topped the
MCQ quizzes published in the journals of the
EU-ACME Office
European Urology will be entitled to a free
registration for the Annual EAU Congress. The
EU-ACME committee believes that this knowledgebased competition would encourage the best and the
most talented to participate. Hence, this exciting
initiative was continued for 2014.
29th Annual EAU Congress to be held in Stockholm
from April 11 to 15, 2014.
From January 1 up to December 31, 2013, interested
EU-ACME members will have to answer multiple
questions published in European Urology.
For details, visit: www.eu-acme.org/europeanurology
Participants who answered the most questions
correctly will be awarded with free registration for the
Winners will be formally notified in early January next
year, and their names published in the February 2014
issue of this newsletter. Good luck to all!
Credit Registry
Reports
electronically!
EU-ACME members may generate and print
Credit Registry Reports online.
If you do not wish to receive hard copy of the
CRR please log in to your online account and
check the box “I will generate and print my
CRR online. I do not wish to receive a copy by
regular mail”.
www.eu-acme.org
EU-ACME MCQ 2012 winners
MCQ initiative draws enthusiastic response
From the period January 1 to December 31 last year, EU-ACME members answered multiple questions
published in European Urology. Participants who answered the most questions correctly were awarded
with free registration for the 28th Annual EAU Congress in Milan held in March this year.
The 2012 winners are:
1. Dr. Jose Angel Cuesta Alcala, Spain (CME-110604)
2. Mr. Mark Saxby, United Kingdom (CME-000243)
3. Mr. Franz-Josef Schattka, Ireland (CME-110659)
EU-ACME committee chairman Prof. R. Nijman congratulated all the winners for their successful
participation in our online CME-programme!
EU-ACME Office
32
March/May 2013
Mirja Ruutu
http://esou.uroweb.org
Loving mother and dedicated urologist
11th Meeting of
the EAU Section
of Oncological
Urology (ESOU)
1943-2013
17-19 January 2014, Prague, Czech Republic
EAU meetings
and courses
are accredited
by the EBU in
compliance with
the UEMS/EACCME
regulations
Prof. Mirja Ruutu passed away last January 20 in
Helsinki at the age of 69 years. She suffered from
gastric cancer for three years.
Mirja Ruutu, or Miitu as we knew her, had a great
career as a urologist, teacher and professor at
Helsinki University Hospital and University of
Helsinki. She was qualified as general surgeon in
1977, urology in 1979, obtained her doctorate in 1985
and became docent in 1987. She worked as a
consultant of urology in the Surgical Hospital until
1994 when she moved to the Meilahti Hospital. Mirja
Ruutu was elected professor of urology in 2002.
European
Association
of Urology
UROLOGY
WEEK
2013
Mirja had a high academic profile in Finnish and
Scandinavian urological communities, and with the
European School of Urology and the European
Board of Urology. She was the first Fellow of the
European Board of Urology (FEBU) in Finland in
1996. For many years she was involved in different
collaboration groups and had administrative
responsibilities in the Scandinavian Association of
Urology.
She was nominated Honorary Member of several
international societies.
Mirja´s many scientific interests included urethral
strictures, biocompatibility and toxicity of catheters,
impotence, prostate and renal cancers and
interstitial cystitis. She was the most popular
opponent in doctoral dissertations in Finland
during the last years. In 2002 Mirja was elected as
Urologist of the Year.
Although Mirja officially retired in January 2008,
she worked as a researcher at our institution until
last December 2012. Mirja´s main hobbies were
horses and dogs. She leaves a husband and three
children.
By Prof. Kimmo Taari
European Urological Scholarship
Programme (EUSP)
Do not forget to submit your online applications for
Short Visit, Clinical Visit, Visiting Professor Programme,
Scholarship and Clinical Research Fellowship before the
next deadline of 1 September 2013!
For more information and application, please contact the
EUSP Office – [email protected] or check our website
http://www.uroweb.org/education/scholarship/
Urology Week is an initiative of the
European Association of Urology,
which brings together national
urological societies, urology
experts and patient groups with
Cut the cord.
the aim to build awareness of
prostate conditions among the
general public. Every year, various
educational and media events
take place during this week
throughout Europe.
VueLite
™
LED LIGHT SOURCE
If you would like to organise an event in your
country or find out more, please visit:
www.urologyweek.org
European
Association
of Urology
MEDICAL
www.cookmedical.com
© COOK 2012
March/May 2013
URO-BEMEAADV-EUTVUE-EN-201212
33
Between bench and clinic
Mont Blanc Senior Visiting
Scholarship Programme
PCTRE: Two-way communication
On 27-28 June 2013, the Swedish city of Malmö will
host the 2nd Meeting on Prostate Cancer Translational
Research in Europe. This meeting is truly unique as it
fosters the vital cooperation between basic research
and practice, offering multiple opportunities for
researchers and practising urologists alike.
According to Prof. Anders Bjartell, the meeting’s local
organiser, the main issue in translational research
today is the establishment of a bi-directional
communication between laboratories and clinical
departments. The PCTRE meeting is perfectly geared
to tackle this issue.
“At this meeting we make sure that the questions from
the clinic are answered from the bench and vice versa,”
explained Prof. Peter Mulders, chairman of the EAU
Research Foundation which co-organises this event.
“We will also be giving an overview of everything that
is currently going on in European research on prostate
cancer: many European programmes will be presented
there, last updates will be given.”
“Because of the interaction between researcher and
practitioners on the floor, the delegates will be
hearing a very balanced discussion on the what might
be the next step in the treatment of prostate cancer.”
Dresden hosts visiting Chinese scholars
This translational meeting provides a unique
opportunity for researchers to understand how
discoveries can be implemented in a clinical setting,
whereas practising urologists will get first-hand
insights into the challenges and ambitions of today’s
PCa research.
Prof. Gang Zhu
Beijing Hospital
Dept. of Urology
Beijing (CN)
“A wide range of research topics will be addressed,
including genomics, animal models, stem cells,
imaging and drug development,” stressed Prof.
Bjartell. “Additionally, we will discuss a very pressing
issue of networking and funding of large-scale
research projects.”
zhugang2000@
gmail.com
“It is of utmost importance that we address the
commercialisation of important discoveries and how
clinical trials should be designed for a successful
outcome. We also need to understand how newly
developed advanced methods can be integrated in
research projects.”
The scientific programme of this event will include a
number of highly interactive sessions, among others
dedicated to omics in personalised medicine,
non-coding RNAs in prostate
cancer, the integration of
biomarkers into clinical utility and
prostate cancer imaging in the next
decade.
This meeting is also a unique
opportunity for young experts to
profile their work and make a step
forward in the European research
community. The organisers invite
all researchers active in this field to
submit their abstracts for
presentation at this meeting.
Visit the official website of the
PCTRE Meeting:
http://pctre2013.uroweb.org
Dresden, Germany hosted the second “Mont Blanc”
Senior Visiting Scholarship Programme on Urogenital
Tumours from March 10 to 14 this year with the
successful participation of a group of Chinese
urologists.
Jointly sponsored by the Chinese Urological
Association (CUA) and the European Association of
Urology (EAU) the programme, named after the
highest peak on mainland Europe, has chosen
Dresden to offer the Chinese participants the
opportunity of learning advanced expertise and
techniques through surgical procedure observation,
interactions and academic exchanges.
Seven Chinese doctors from various cities in China
participated in this year’s programme, namely: Gang
Zhu and Tongwen Ou (Beijing); Guoqing Ding
(Zhejiang); Zhiquan Hu (Wuhan); Quanlin Li (Dalian),
Yonghui Chen (Shanghai) and Yuchun Zhu (Sichuan).
Ms. Ren Yang, executive director of the Chinese
School of Urology, accompanied the participants led
by Prof. Gang Zhu.
The visiting scholars spent three days with their
German colleagues and joined various activities such
as surgical procedures, visiting facilities, ward rounds,
multi-disciplinary meetings and oncological
consultations at the Urological Department of Carl
Prostate Cancer Translational
Research in Europe (PCTRE)
Session 1: Omics in personalized
medicine
Chairs: G. Jenster, Rotterdam (NL)
O. Kallioniemi, Helsinki (FI)
08.40 – 08.55
Advances in technology and
informatics drive personalised
cancer medicine
Sequencing cancer genomes: From
research to future diagnostics
M. Rubin, New York (US)
Analysis of prostate cancer by
next-gen sequencing
J. Weischenfeldt, Heidelberg (DE)
Germline genetic profiles –
implications for targeted screening
R. Eeles, London (GB)
Panel discussion
G. Jenster, Rotterdam (NL)
09.35 – 09.55
09.55 – 10.10
10.10 – 10.40
Break and poster viewing
10.40 – 12.00
Session 2: Non-coding RNAs in
prostate cancer
Chairs: T. Visakorpi, Tampere (FI)
10.40 – 11.00
11.00 – 11.15
11.15 – 11.30
11.30 – 11.45
All of the participants have wonderful memories of
the visit and we are certainly inspired and committed
to share with our Chinese colleagues the knowledge
and experience we have gained.
For more information please contact Congress Consultants
miRNAs: implications for
personalized medicine
N. Zaffaroni, Milan (IT)
The therapeutic implications of
miR-34c in PCa
Y. Ceder, Malmö (SE)
Why are snoRNAs and tRNAs
differentially expressed in prostate
cancer?
E. Martens-Uzunova, Rotterdam (NL)
Novel lncRNAs in CRPC
T. Visakorpi, Tampere (FI)
11.45 – 12.00
Panel discussion
T. Visakorpi, Tampere (FI)
12.00 – 13.00
Lunch and poster viewing
13.00 – 14.20
Session 3: Integrating biomarkers
into clinical utility
Chairs: J. Schalken, Nijmegen (NL)
W. Watson, Dublin (IR)
13.00 – 13.25
Prostate cancer biomarkers –
addressing the clincial question
E. Steyerberg, Rotterdam (NL)
The long and winding road of the
biomarker regulatory approval
process
J. Schalken, Nijmegen (NL)
The Movember Global Action Plan
on prostate cancer biomarkers
C. Nelson, Brisbane (AU)
Panel discussion on ‘What are the
bottlenecks of biomarker clinical
utility’
C. Bangma, Rotterdam (NL)
H. Lilja, New York (US)
13.25 – 13.40
13.40 – 14.00
14.00 – 14.20
14.20 – 15.00
15.00 – 16.30
Session 4: Funding or prostate
cancer research in Europe
Chairs: P-A. Abrahamsson,
Malmö (SE)
C. Bangma, Rotterdam (NL)
15.00 – 15.10
15.10 – 15.25
15.25 – 15.40
15.40 – 15.55
European
15.55 – 16.10
Association
16.10 – 16.30
of Urology
34
Welcome and introduction
P-A. Abrahamsson, Malmö (SE)
P. Mulders, Nijmegen (NL)
08.40 – 10.10
09.15 – 09.35
One of the social highlights was the awarding
ceremony when Prof. Zhu was granted by Prof. Wirth,
on behalf of the EAU, an EAU collar badge in
recognition of his contribution to the CUA-EAU
collaboration.
http://pctre2013.uroweb.org
Thursday, 27 June 2013
08.55 – 09.15
During the knowledge exchange session, our German
colleagues presented their studies on siRNA-mediated
inhibition of antiapoptotic genes in bladder cancer
cells, new drugs for overactive bladder, ultrasound
and MRI fusion technique for prostate biopsy and the
surgical management of vena cava thrombi in
advanced kidney cancer. The author shared his
experiences and techniques in the use of LESS surgery
in urology and treatment options for localised
prostate cancer such as comparing radical
prostatectomy against active surveillance. On the
other hand, Prof. Yuchu Zhu reported on evidencebased medicine results in Chinese urology. Clearly,
through this bilateral exchange we can efficiently
share our respective insights and actual clinical
experience.
27-28 June 2013, Malmö, Sweden
08.30 – 08.40
Gustav Carus Hospital, Dresden University of
Technology, Germany. Headed by Prof. Manfred Wirth,
the Department of Urology of the Carl Gustav Carus
Hospital is considered as one of Germany’s largest
urological centers and has comprehensive knowledge
and experience in treating urogenital tumours.
Our group was impressed by the standardized quality
medical care provided by the urological team.
Moreover, the multi-disciplinary meetings also
convinced us that close collaboration among the
specialties of urology, oncology and radiology can
vastly improve the delivery of optimal service to
cancer patients.
Overview of prostate cancer
research funded by the European
Commission
E. Schenk, Rotterdam (NL)
Cancer research funding in
Horizon 2020
M. Griethuysen, Rotterdam (NL)
European public-private
partnerships: Current experiences
and the future
R. Graeser, Beerse (BE)
Role for patient organisations in
Horizon 2020
T. Hudson, Dublin (IR)
Movember in Europe
P. Villanti, Melborne (AU)
Panel discussion
16.30 – 17.45
Poster session
Chairs: S. Fuessel, Dresden (DE)
W. Watson, Dublin (IR)
12.10 – 13.10
Lunch and poster viewing
13.10 – 14.25
Session 7: Drug development from
bench to bed
Chairs: Z. Culig, Innsbruck (AT)
I. Mills, Oslo (NO)
13.10 – 13.30
Androgen ablation and
combination therapies in prostate
cancer: New targets
P. Rocchi, Marseille (FR)
A dark side of the androgen
ablation therapy: cofactors and
oncogenes up-regulated during
androgen ablation
F. Santer, Innsbruck (AT)
Immuno-therapy for prostate
cancer
TBC
Panel discussion
Z. Culig, Innsbruck (AT)
I. Mills, Oslo (NO)
Friday, 28 June 2013
08.30 – 10.00
08.30 – 08.55
08.55 – 09.10
09.10 – 09.25
09.25 – 09.40
09.40 – 10.00
Session 5: Stem cells and animal
models
Chairs: N. Maitland, York (GB)
C. Robson, Newcastleupon-Tyne (GB)
Mechanisms regulating prostate
cancer stem cells
M. Ousset, Brussels (BE)
Alternatives to animal models to
study prostate stem cells
R. Heer, Newcastle-upon-Tyne (GB)
Understanding the complexity of
prostate cancer initiating cells:
Implications for therapy
A. Collins, York (GB)
Tumorigenesis and metastasis of
urological malignancies, a cancer
stem cell perspective
G. Van Der Horst, Leiden (NL)
Panel discussion
N. Maitland, York (GB)
C. Robson, Newcastle-uponTyne (GB)
10.00 – 10.30
10.30 – 12.10
Session 6: Prostate cancer imaging
in the next decade
Chairs: A. Bjartell, Malmö (SE)
W. Van Weerden,
Rotterdam (NL)
10.30 – 10.45
The Webmicroscope
J. Lundin, Helsinki (FI)
Fast Path EU Project
W. Gallagher, Dublin (IR)
Prostate cancer imaging from
animals to humans
D. Ulmert, Malmö (SE)
Diagnostic imaging of prostate
cancer
R. Reiter, Los Angeles (US)
Panel discussion
W. Van Weerden, Rotterdam (NL)
10.45 – 11.00
11.00 – 11.20
11.20 – 11.50
11.50 – 12.10
13.30 – 13.50
13.50 – 14.10
14.10 – 14.25
14.25 – 14.30
Closure
P-A. Abrahamsson, Malmö (SE)
Organising committee
Prof. P-A. Abrahamsson, Malmö (SE)
Prof. C. Bangma, Rotterdam (NL)
Prof. A. Bjartell, Malmö (SE)
Prof. Z. Culig, Innsbruck (AT)
Dr. S. Fuessel, Dresden (DE)
Prof. F. Hamdy, Oxford (GB)
Dr. G. Jenster, Rotterdam (NL)
Prof. O. Kallioniemi, Helsinki (FI)
Dr. H. Lilja, New York (US)
Prof. N. Maitland, York (GB)
Dr. I. Mills, Oslo (NO)
Prof. P. Mulders, Nijmegen (NL)
Prof. C. Robson, Newcastle upon Tyne (GB)
Prof. J. Schalken, Nijmegen (NL)
Dr. E. Schenk, Rotterdam (NL)
Prof. T. Visakorpi, Tampere (FI)
Prof. W. Watson, Dublin (IE)
March/May 2013
2nd Meeting of the EAU Section of
Urolithiasis (EULIS)
For more information please contact Congress Consultants at
[email protected] or go to
http://eulis.uroweb.org
5-7 September 2013, Copenhagen, Denmark
Wednesday 4 September 2013
SWL - Who needs a stent?
H-G. Tiselius, Stockholm (SW)
Prolonged stenting in stone patients: what are the
problems?
N. Buchholz, London (UK)
1st International EULIS pre-conference symposium on metal
stenting of the ureter
Copenhagen University Hospital Rigshospitalet
08.30 - 17.00
Live Surgery
Moderators: N. Buchholz, London (UK)
M. Holm, Copenhagen (DK)
08.30 - 08.50
08.50 - 09.50
09.50 - 10.10
10.10 - 10.35
The role of metal in the world of stents
LIVE insertion Allium stent
Physics of metal in stents made easy
The Allium stent
10.35 - 10.50
Coffee break
10.50 - 11.50
Live insertion Resonance stent
E. Liatsikos, Patras (GR)
11.50 – 12.15 The Uventa stent
12.15 - 13.00
Lunch break
13.00 - 14.00
14.00 - 14.25
LIVE insertion Uventa stent
The Memokath stent
The Resonance stent
LIVE insertion Memokath stent
Encrustation models and shock wave treatment of
encrusted metal stents
14.25 - 14.45
14.45 - 15.45
15.45 - 16.05
16.05 - 16.25
Coffee break
16.25 - 16.45
Ureter stents – What does the future hold?
Farewell - M. Holm, Copenhagen (DK)
16.45 - 17.00
14.00 - 15.30
15.30 - 16.00
Coffee break
16.00 - 17.30
Poster Session 4: Inhibitors and promoters /
pathphysiology upper urinary tract / genetics
Chairs: H. Jung, Fredericia (DK)
D. Kok, Rotterdam (NL)
Macromolecules and stones - what do we know?
Genetic basis of macromolecular modifications and
their role in stone formation
S. Khan, Gainesville (US)
16.00 - 17.30
Opening - P. Osther, Frederica (DK)
08.35 - 10.35
Keynote lectures 1
Chairs: K. H. Andreassen, Frederica (DK)
P. Osther, Frederica (DK)
Formation of Randall’s plaques and their
involvement in stone formation
Trends in PCNL - What have we learned from the
CROES study?
J. de la Rosette, Amsterdam (NL)
Modern management of stones in children
K. Sarica, Istanbul (TR)
Retention and growth of urinary stones: Insights
from imaging
J. Williams, Indianapolis (US)
Case discussion: Nightmare session
Chair: T. Knoll, Sindelfingen (DE)
Panel: N. Buchholz, London (UK)
C. Chaussy, Regensburg (DE)
B. Hess, Zürich (CH)
T. Knoll, Sindelfingen (DE)
J. Reis-Santos, Lisbon (PT)
10.35 - 11.00
Coffee break
11.00 - 13.00
Update on stone disease 1
Chairs: H-G. Tiselius, Stockholm (SE)
A. Trinchieri, Milan (IT)
Update on stone surgery 1
Chairs: H. Ather, Karachi (PK)
A. Hoznek, Paris (FR)
Friday, 6 September 2013
08.30 - 17.00
G. Guisti, Milan (IT)
C. Scoffone, Turin (IT)
RIRS for large stone
Surgeon: O. Traxer, Paris (FR)
Prone vs. Supine vs. Lateral PCNL: Status quo and
perspectives
A. Papatsoris, Athens (GR)
Mini-PCNL
Surgeon: T. Knoll, Sindelfengen (DE)
Supine PCNL with ultrasound-guided puncture
Surgeon:
T.B.C.
IPAD assisted percutaneous access to the kidney Fact or fiction?
T.B.C.
Debate: Maxi, mini, ulta-mini, micro PCNL - The
smaller, the better?
Mini-PCNL
S. Lahme, Pforzheim (DE)
Ultra-mini PCNL
J. Desai, Ahmedabad (IN)
Pediatric stone therapy: Arguments for endoscopy
and against SWL
M. Straub, Munich (DE)
RIRS
Surgeon: K. Andreassen, Frederica (DK)
Semirigid URS using Backstop
Surgeon: G. Guisti, Milan (IT)
Expanding the indications for RIRS
A. Breda, Barcelona (ES)
Avoiding complications in URS
M. Brehmer, Stockholm (SE)
Baskets, wires, energy sources. What should be in
the OR?
08.30 - 10.30
13.00 - 14.00
Lunch break
14.00 - 15.30
Poster Session 2: Stones & metabolism
Chairs: J. Galan, Alicante (ES)
10.30 - 11.00
Coffee break
11.00 - 13.00
Update on stone disease 2
Chairs: B. Hess, Zurich (CH)
J.A. Meneses, Belo Horizonte (BR)
Nephron pathophysiology in calcium nephrolithiasis
R. Unwin, London (UK)
Improving patient compliance to life style advice
C. Bach, London (UK)
Does the economic crisis affect incidence of
urolithiasis?
J. Reis-Santos, Lisbon (PT)
EAU patient information Project
T. Bach, Hamburg (DE)
Impact of metaphylaxis on renal function in active
kidney stone formers
J.A. Meneses, Belo Horizonte (BR)
Gender aspects in the treatment of urolithiasis
C. Seitz, Vienna (AT)
Dietary acid load and renal stone formation
A. Trinchieri, Milan (IT)
Cardiovascular disease and kidney stones
T.B.C.
14.00 - 15.30
Poster Session 3: SWL/ stents
Chairs: C. Chaussy, Regensburg (DE)
European
Association
of Urology
March/May 2013
Update on SWL
Chairs: K.H. Andreassen, Frederica (DK)
M. Hanna, London (UK)
SWL - Is it possible to go any further
H-G. Tiselius, Stockholm (SE)
Inversion, hydration and diuresis during SWL - Does
it improve outcome?
H. Ather, Karachi (PK)
Renal haematoma after SWL
H-M. Fritsche, Regensburg (DE)
Pain management during SWL
M. Hanna, London (UK)
Predicting stone fragmentation in SWL using
imaging
SWL - How to avoid complications
M. Alomar, Riyahd (SA)
First European experience with the XininEisenmenger lithotripter
J. Rassweiler, Heilbronn (DE)
Poster Session 1: Paediatric Urolithiasis /
experimental Urolithiasis
Chair: B. Hoppe, Cologne (DE)
Primary hyperoxaluria - Anything new?
B. Hoppe, Cologne (DE)
Experimental models in urolithiasis
14.00 - 15.30
13.00 - 14.00
Poster session 7: Basic research
Chairs: H-G. Tiselius, Stockholm (SE)
Clinical implications of physcochemistry in stone
formation
Role of calcium phosphate in calcium oxalate
crystallization
14.00 - 15.30
HOT workshop 3: SWL - Frederiksberg Hospital
Chairs: C. Chaussy, Regensburg (DE)
How to improve outcome in SWL
Complications of SWL
SWL in children
T.B.C.
Practical demonstrations of positioning and stone
targeting
15.30 - 16.00
Coffee Break
15.30 - 17.30
Poster Session 8: Imaging & pain management
Chairs: O. Graumann, Fredericia (DK)
K. Venborg Pedersen, Fredericia (DK)
Sub-plenary session: Live surgery
Chairs: A. Ng, Hong Kong (HK)
B. Turna, Izmir (TR)
ECIRS
Surgeons:
The wonder of ECIRS
RIRS compared to PCNL
A. Skolarikos, Athens (GR)
Can we prevent complications in URS
P. Geavlete, Bucharest (RO)
Endourology in upper urinary tract stenosis
RIRS: What can expect in the future?
O. Traxer, Paris (FR)
Management of stones in pregnancy
11.00 - 13.00
HOT workshop 2 - SWL - Herlev Hospital
Chairs: S. Osther, Fredericia (DK)
Poster session 6: Metaphylaxis in stone formers
Chairs: R. Siener, Bonn (DE)
F. Keeley, Bristol (UK)
Evidence based medicine: Efficacy of stone
prevention
How realistic is metabolic stone management in
developing countries?
H. Ather, Karachi (PK)
Poster Session 5: PCNL/ URS I
Chairs: S. Lahme, Pforzheim (DE)
I. Saltirov,Sofia (BL)
How to improve outcome in SWL
Imaging in SWL
S. Osther, Frederica (DK)
Pain management during SWL
T.B.C.
Complications of SWL
K. Andreassen, Frederica (DK)
Practical demonstrations of positioning and stone
targeting
Are we facing a new era in metabolics? Impact of
endoscopic findings on recurrence prevention
M. Straub, Munich (DE)
Alkali citrate - a panacea for medical treatment of
all kidney stones?
Dietary renal acid load and emerging welfare
pathologies
T.B.C.
When to suspect a genetic disorder in a patient
with renal stones - and why?
G. Gambaro, Rome (IT)
Dietary factors and life style
R. Siener, Bonn (DE)
An update and practical guide to renal stone
management
W. Robertson, London (UK)
11.00 - 13.00
14.00 - 15.30
Refining indications for PCNL
Management of complications in PCNL
16.00 - 17.30
Update on stone management
Chairs: J. Reis-Santos, Lisbon (PT)
R. Swartz, Örebro (SE)
Post-Ureteroscopic Lesions
M. Schönthaler, Freiburg (DE)
Mechanical pushing and pulling forces during URS
Ø. Ulvik, Bønes (NO)
Compliance to prophylaxis in remal stone formers can we do better?
A. Trinchieri, Lecco (IT)
What does the urologist ask the nephrologist
What does the nephrologist ask the urologist?
Outcome of stone treatment: What is the most
suitable definition of stone free
HOT workshop 1 - URS & laser
Chairs: R. Swartz, Örebro (SE)
Which scope?
A. Papatsoris, Athens (GR)
How to improve RIRS outcome: Update on laser
settings and irrigation
Complications of URS
P. Geavlete, Bucharest (RO)
Hands-on model training
Thursday, 5 September 2013
08.30 - 08.35
14.00 - 15.30
Imaging in pediatric urolithiasis
T.B.C.
Upper urinary tract pain management
K. Venborg Pedersen, Fredericia (DK)
15.30 - 17.30
Poster Session 9: Stones in animals / Clinical
therapy in humans / Guidelines
Chairs: T. Bach, Hamburg (DE)
C. Türk, Vienna, (AT)
What’s new in the EAU Urolithiasis guidelines
C. Türk, Vienna, (AT)
Lessons learnt from animals
W. Robertson, London (UK)
16.00 - 17.30
Workshop 4: Non-surgical stone treatment
Chairs: G. Gambaro, Rome (IT)
Dietary management of urolithiasis: What are the
evidence?
R. Siener, Bonn (DE)
Medical management: What are the evidence?
Chronic kidney disease and urolithiasis
Patient education
Case discussions
Saturday, 7 September 2013
08.30 - 09.10
Keynote lectures 2
Chairs: D. Kok, Rotterdam (NL)
P. Osther, Fredericia (DK)
08.30 - 09.10
Debate: Urinary saturation in stone disease: Casual
or Causal?
Casual: W. Robertson, London (UK)
Causal: H-G. Tiselius, Stockholm (SE)
09.10 - 10.10
Race, Urolithiasis and Diversity
Chairs: H. Ather, Karachi (PK)
Diversity in stone composition
Diversity in lithogenic risk factors
Diversity in Stone Mangement Strategies
P. Alken, Mannheim (DE)
08.30 - 10.30
HOT workshop 5: PCNL
Chairs: M. Brehmer, Stockholm (SE)
Positioning in PCNL
Imaging and access
M. Brehmer, Stockholm (SE)
Stone fragmentation
Future aspects of PCNL
A. Hoznek, Creteil (FR)
Hands-on model work
10.30 - 10.40
Best published paper lecture
10.40 - 11.05
Souvenir session
11.05 - 12.30
ESD 2014/ EULIS 2015
J. Galan, Alicante (ES)
12.30 - 13.00
Presentation of new chairman and farewell
Lunch break
35
Accrual Workshop MAGNOLIA trial
Interactive, case-based learning activities to boost recruitment
Dr. Wim Witjes
Scientific and Clinical
Research Director
EAU Research
Foundation, Arnhem,
The Netherlands
[email protected]
Dr. Raymond
Schipper
Clinical Project
Manager
EAU Research
Foundation, Arnhem,
The Netherlands
trial is challenging, involving different disciplines
(urology, oncology, radiology and pathology) and is
targeted at a complex patient population.
The workshop was designed for investigators and
their research staff to discuss the recruitment
challenges and exchange ideas how to efficiently
organize, identify and manage patients for the study.
The three-hour programme started with updates on
the study status and recruitment strategies. Two
presentations by Prof. Colombel (Lyon, FR) and Dr.
Peter Goebell (Erlangen, DE) provided the audience
with strong arguments to give priority to the
MAGNOLIA study instead of neo-adjuvant
chemotherapy and adjuvant chemotherapy.
Prof. Llorente (Alcorcon, ES) and Prof. Colombo (Milan,
IT) presented and discussed patient cases to identify
the appropriate patients based on the trial’s inclusion
and exclusion criteria and highlighted the importance
of a coordinator who oversees all study activities and
can initiate and accelerate study procedures within the
participating hospital. In the second part of the
workshop the participants were split in groups to
discuss a particular theme (ICF procedures, Screen
Failures, Pathology). These sessions yielded important
information on the challenges that sites are facing to
recruit patients and the possible actions that can be
undertaken to enhance accrual.
patients and their family was considered crucial.
Furthermore, the use of the TUR material would
definitely improve the quality of the samples and the
number of samples available for the MAGE-A3
expression. The output of the discussions will be
compiled in a report that will be sent to all
MAGNOLIA sites.
The meeting participants enthusiastically commented
on the workshop and said that the programme was
informative and interesting. Similar meetings will
also be organised on a national level in the future. For
making this first Accrual Workshop very inspiring and
successful, the EAU-RF thanks all speakers and
participants!
There was a consensus about the need to have a
shortened set of information for the patients like a
patient leaflet and to add an inclusion/exclusion
checklist to the first ICF. In addition to the actions on
the ICFs, an optimal collaboration between the study
For more information on the MAGNOLIA study please
staff and the patients to answer all questions from the visit the website: http://magnolia.uroweb.org
r.schipper@
uroweb.org
The EAU Research Foundation (EAU-RF) held its first
Accrual Workshop for the MAGNOLIA study last
March 16 in Milan, Italy, coinciding with the 28th
Annual EAU congress.
The meeting generated a high level of interest and
was well attended by 55 delegates from 37 sites of all
participating countries (Germany, France, Spain, Italy,
The Netherlands, Poland, Czech Republic, Romania,
Ukraine, Russia) including PI’s, sub-investigators,
research coordinators, research nurses and
pathologists.
The MAGNOLIA study is a double-blinded phase II
trial in which the safety and efficacy of antigen
specific cancer immunotherapy with recMAGE-A3 +
AS15 in patients with muscle invasive bladder cancer
after radical cystectomy is evaluated. The MAGNOLIA
EAU Research Foundation
Group photo of the participants of the MAGNOLIA Accrual Workshop in Milan
Prostate and kidney dilemmas
EMUC2013
Amsterdam to host 2nd International Conference
Current controversies, challenging treatment
dilemmas and recent developments on prostate and
kidney cancers will be the focus of the 2nd
International State-of-the-Art Conference on Prostate
and Kidney Cancers.
To be held in Amsterdam from 26 and 27 September,
the two-day conference will gather some of the
world’s leading experts on prostate and kidney
cancers to the Dutch capital to carefully examine
current treatment strategies, best practices and
prospects for optimal management.
“The two-day conference will provide a clinicallybased overview of the current therapeutic dilemmas
with an emphasis on the opportunities for
multidisciplinary management. Topics are current
controversies, recent developments in the field, and
complex cases, in addition to the cutting edge
research and the latest developments,” said the
Scientific Committee of the European Uro-Oncology
Group.
The meeting will not only
enable clinicians to stay
up-to-date with new
information on daily clinical
practice, but the meeting
will also provide a
comprehensive and concise
insight into the state-of-theart approach to treating
prostate and kidney cancers.
“There will be interactive
discussions to engage the
participants, and
programme will appeal to
the practicing physician and
scientists in many ways,”
said Prof. Susanne Osanto
(NL), who leads the
organising committee.
36
Moreover, specialists such as medical oncologists will
have an opportunity to meet recognized experts who
will provide updates on both the scientific and clinical
aspects of genito-urinary cancers.
“We aim that these updates will have an immediate
impact on clinical practice or current research
efforts,” added Osanto.
Some of the topics to be discussed are optimal
treatment of localized renal cell carcinoma (RCC),
metastatic RCC, surgery in oligometastatic RCC,
localized prostate cancer (PCa), treatment of
oligometastatic disease, metastatic PCa, contemporary
approaches, and clinical metastases and response
assessment issues in clinical trials
To be held at the InterContinental Amstel Hotel
Amsterdam, EACCME accreditation will be requested
for 12 points. Further information and queries can be
sent to [email protected] or access the website
at http://euog.org/
5th European Multidisciplinary Meeting
on Urological Cancers
Embracing Excellence in Treatment of Prostate,
Bladder and Kidney Cancer
From guidelines to personalised medicine
15-17 November 2013, Marseille, France
Abstract deadline: 8 July 2013
www.emuc2013.org
Organised by
March/May 2013
www.reviews
Dr. Andrea Cestari
Section Editor
Milan (IT)
journal articles in urology right to your desktop,
smartphone, or tablet.
The content available on PracticeUpdate has already
been vetted by the top minds in urology and filtered
to match the specific areas of interest to the reader or
user.Registering is very easy and free of charge and it
is worthwile to have a log-in account for easy access.
[email protected]
www.ehealthcareers.com/
www.practiceupdate.com/
urology
As practising urologists, we are all aware how
challenging it can be to know what really matters to
our practice, particularly with the volume of
constantly evolving information that are available in
the web.
The new “PracticeUpdate” website created by Elsevier
is a valuable new online tool that provides access to
information of great interest to urologists, and
presented in a very convenient and attractive manner.
As you go through the pages of this website, one
realises that there’s no need to waste time skimming
journal articles, jumping from site to site in order to
stay on top of what’s happening in urology.
PracticeUpdate does all the work for you. It delivers
the latest, most pertinent news, developments and
Are you planning to look for a job in the United
States? Or are you searching for a fellowship
programme as well? This website will be probably of
help. eHealthCareers.com brings you the latest
urology jobs straight from the pages of The Journal of
Urology .
Once registered, and when you set up job alerts from
this website, you’ll see or receive alerts only on the
jobs you’re interested in. After you provide
information on specialty and location, the website
will send an alert when a matching job gets posted.
Moreover, it is possible to directly scroll for detailed
information on a particular job or position posted on
this website.
The website also features videos, articles and
provides an accelerated job search. Users can also
post their resumes, and prospective employers are
also featured to highlight their services and vacancies.
Certainly, for a one-stop website focused on a
comprehensive job search ehealthcareers is a helpful
and convenient tool to have in your desktop.
http://cem.uroweb.org
EAU 13th Central
European Meeting
(CEM)
4-6 October 2013, Prague, Czech Republic
EAU meetings
and courses
are accredited
by the EBU in
compliance with
the UEMS/EACCME
regulations
Call for Abstracts
deadline 1 August 2013
European
Association
of Urology
www.reviews
Tübingen hosts joint meeting
Section offices pool efforts for an in-depth meeting
http://esffu-esgurs-esou.uroweb.org
By Joel Vega
2nd Joint Section Meeting of
ESFFU, ESGURS and ESOU
Three frontline EAU section offices have pooled
efforts to organise and hold an in-depth meeting that
will tackle the challenges and issues in andrology,
onco-urology functional, female and reconstructive
urology, marking the second time of close
collaboration among these specialities.
and male incontinence, surgical treatment of prostate
and bladder cancers, surgical troubleshooting in
neobladder complications and medical strategies for
incontinence.
Live surgeries will also be scheduled during the
meeting with moderated sessions that will
demonstrate surgical procedures such as radical
cystectomy and prostatectomy, surgical options for
Tübingen, Germany will host from October 10 to 12 this male and female incontinence, anterior and posterior
year the 2nd Joint Section Meeting of the EAU Section of urethroplasties, and troubleshooting procedures in
Female and Functional Urology (ESFFU), EAU Section of male slings, rectourethral fistulas and parastomal
hernias, to name a few.
Genitourinary Reconstructive Surgeons (ESGURS) and
the EAU Section of Oncological Urology (ESOU).
Prof. John Heesakkers, ESFFU chairman, said the
“...how various specialties attempt meeting will not only shed practical insights on
issues encountered by specialists on female
to achieve optimal follow-up care, various
and functional urology, but will also look into the
impact of these procedures on diagnosis, disease
prevent complications and other
progression, complications, and medical options.
management issues...”
“Not only do we aim to present the insights and
perspectives of veteran specialists, but also intend to
promote a closer collaboration among young and
expert practitioners. This meeting is an ideal platform
for them to exchange best practices that will inform
their treatment strategies,” said the organisers.
With Prof. Karl-Dietrich Sievert leading local
organisers, the meeting will present a scientific
programme focusing on recent advances and how
various surgical and medical strategies impact on the
aim of urologists to provide optimal medical care.
“Best practices will be presented and examined, and
how various specialties attempt to achieve optimal
follow-up care, prevent complications and other
management issues will be thoroughly discussed and
examined by an expert faculty, while opening the
discussion to participants,” said Sievert.
Among the issues and topics to be discussed are
urethroplasty techniques, surgical options for female
March/May 2013
EAU Section of Female and Functional Urology (ESFFU)
EAU Section of Genito-Urinary Reconstructive Surgeons (ESGURS)
EAU Section of Oncological Urology (ESOU)
10-12 October 2013, Tübingen, Germany
EAU meetings
and courses
are accredited
by the EBU in
compliance with
the UEMS/EACCME
regulations
“Opinion leaders will demonstrate new techniques
and look into the controversial issues ranging from
surgical treatment for prostate and bladder cancers,
prospects and current trends in managing
incontinence, surgical troubleshooting procedures to
medical options,” said Heesakkers.
The organisers said one advantage of holding joint
meetings with other specialities is that actual clinical
challenges can be discussed in a more thorough
manner, with the various opinions of experienced
specialists adding depth to the discussion.
A technical exhibit will also be concurrently held with
the three-day event to provide an overview of new
technologies used in the diagnosis and treatment of
various urological diseases.
The organisers also invite participants to join the
abstract sessions and submit the results of their
research studies. Deadline for abstract submission
will be on July 9, 2013, with the final selection or
outcome of the abstract review available by August.
European
Association
of Urology
37
Overview report: 14th International EAUN Meeting
Milan meeting draws enthusiastic approval from urology nurses
The three-day 14th International EAUN Meeting in
Milan last March gathered around 400 participants
for a varied scientific programme that covers a range
of topics including controversies in post-operative
procedures to specialised nursing care of patients
with urological cancers and bladder dysfunction.
practice, which was very interesting to work on,” said
Beije and Van Der Scheer. “We tried to inform our
urology colleagues as much as possible about our
patient. Presenting the case was an opportunity to
share knowledge with our colleagues from other
countries and to find out if we are on the right track.“
The case deals with complicated ostomy and wound
care after cystectomy and Bricker deviation (with
complex co-morbidity). “We don’t often see such big
problems with such a good result, although together
with our patients we face challenging issues every
day,” they added.
Ms. Dora Mair presenting at the Bladder dysfunction session
Pros and cons regarding prostate cancer screening
was one of the issues discussed with a panel of
prostate cancer experts from Europe sharing their
views on the controversial subject.
Both nurses also said that they learned from the case
the importance of good communication and
documentation of nursing problems and
interventions. “A colleague asked what we could have
done differently. Our answer was that the nursing
discharge document should not be open to multiple
interpretations,” Beije said. “Although we thought the
information we gave the patient was clear (text,
European nurses visit the hospital San Raffaele Turro
The revamped EAUN booth drew much attention
Willem De Blok, a Dutch nurse, explained indications
and preparations for cystoscopy, legal aspects,
experiences of nurses practising cystoscopies, and
discussed some clinical cases.
The chief of the nursing department of urology gave a
presentation, and mentioned that in their clinic there
are two wards for urologic patients: one for the
uninsured patients and another for those with
insurance. The ward for patients with insurance is a
VIP ward with spacious rooms and with a second bed
for a family member, a large bathroom and a little
lounge.
A representative of Olympus Europe Holding GmbH,
She also discussed the new clinical routine for robotic
prostatectomy surgery, and mentioned the following
points regarding the new routine:
1. No bowel washout day before operation but only
a little enema in the evening and morning prior
to the operation. The patient can eat normally the
evening before, and in most cases the patient can
also have meals after the operation;
2. No epidural painkillers or opiates after the
operation; and
3. Mobilisation in bed on the day of the operation
and a few hours out of bed the day after the
operation.
“Both nurses also said that
they learned from the case the
importance of good communication
and documentation of nursing
problems and interventions.”
Roderick Van Den Bergh (NL) presented the pro-view
on PSA screening while Klaus Brasso (DK) provided
the opposing opinion. The presentations were later
followed by a panel discussion with Brasso, Karen
Flynn Thomas (IE) and Erik Van Muilekom (NL) as
members. Moderated by Van Den Bergh, the panel
carefully examined the benefits of early detection,
while weighing its drawbacks in some groups of
patients.
The results of the new clinical routine for robotic
prostatectomy
Jury members Jerome Marley, Veronika Geng and Michael Borre watch the presentation of a research plan in the Research Plan
Competition session
photos), it led to problems. Sometimes, (whenever
possible) bedside teaching could be a solution.”
“The truth probably lies somewhere in the middle,”
said Van Den Bergh. He added: “PSA screening at a
population level reduces PCa mortality by 21 to 29%,
while at the same time PSA screening results in a
large over-diagnosis of 50%.”
Comments from the audience also indicated that
patients’ views must be carefully considered as some
patients prefer active treatment from doctors over
so-called watchful waiting strategies.
Video abstract session
The video abstract session “Inside the body: Surgery in
Motion,” a new feature in the EAUN programme also
received high praise in post-meeting surveys. Several
participants remarked that this session was very
interesting and instructional and should definitely be
repeated in Stockholm.
Presenting a difficult case
Two Dutch nurses, Marjette Beije and Alice Van Der
Scheer from the Netherlands Cancer Institute (NL),
presented a difficult case in the session “Nursing
solutions in difficult cases & case discussions” this year
and enthusiastically shared their experience.
“In Milan, we presented a difficult case from our daily
From left: Particpants Enzo Federico (IT) and Maria Russo (IT)
with cystoscopy trainer Carmen Sommers (NL)
38
Sven Boettjer, presented the history and development
of the equipment and the technical aspects, and
introduced the scopes and the five stations that are
They added that the difficult case presentation made
used. In small groups, the participants performed
them more aware of the role of their skills, their
several tasks with various scopes. Although nurses
interventions and its impact on the treatment. “Did
are not likely to perform tumour resections in actual
we overlook something or are there other aspects that practice, the bladder models proved very convenient
could have been improved? For us it was a great
and popular during the demonstrations. With the kind
opportunity to examine these issues by participating
help of Lisette Van De Bilt and Carmen Sommers,
in Milan.”
nurse practitioners (NL), the team assisted and
mentored the 23 participants.
They also noted that it was a challenge to present the
case in English within the given time (10 minutes)
A follow-up evaluation showed that the course itself,
with an international audience as they were
the content and the way the course was presented
prompted to get straight to the main questions, which were well-appreciated. Participants commented that a
actually helped to get a clear look of the main
different timeslot and the use of video recordings of
problems.
cystoscopies of anomalies can further improve the
course.
Cystoscopy course: positive feedback
One of the main goals of the EAUN is to fill in gaps in Overall, and with the participants giving a positive
nursing education. The EAUN board considered a
response, the EAUN Board is considering to again
cystoscopy course for nurses as one of the needs and offer the course in next year’s programme in
the course in Milan served as a test for offering an
Stockholm, Sweden. Obviously, the support of the
accredited course. In some countries patients are
ESU and Olympus is very crucial and hopefully we will
provided with a cystoscopy in a nurse-led clinic, and
again collaborate with them next year.
in the US, the UK, Scandinavia and the Netherlands,
especially trained nurses are familiar with performing Visit to the San Raffaele Hospital
cystoscopies independently. This is certainly not the
Some nurses also visited the local San Raffaele and
case in all countries, and as far as the EAUN is
San Raffaele Turro hospitals to get an impression of
concerned this need also not be the goal.
urology nursing practice in Italy. Cel Vandewinkel
from Belgium reported: “I and about 20 other nurses
There is no doubt that nurses who run nurse-led
from different countries had the luck to visit the San
cystoscopy clinics are well-trained since most nurses
Raffaele Hospital in Milan established 150 years ago,
are trained on the job and have had their training
and which used to be a psychiatric hospital.
directly from the urologists in actual clinical practice.
Often their training is based on the so-called “do
one-see one-teach one principle.” Trained nurses
recommend that offering good theoretical education
should be the basis, alongside a hands-on training
session. In Milan, nurses who do not perform
cystoscopies themselves also proved to be interested
to participate in such courses.
Frank d’Ancona, a Dutch urologist, introduced the
course with a lecture on anatomy and physiology of
the bladder, embryology, anatomy and anomalies and
pathology of the urological system. Lawrence
Urodynamic examination room in the Urology department
Drudge-Coates, clinical nurse specialist (UK) and
Free mobilisation
Gas canalisation
Stool canalisation
Pain VNS scale
Presence of postoperative nausea
Discharge after:
Conventional
51h.
43h.
94h.
3,65
After clinical path
29.5h
29.5h.
88h.
1,85
13,5%
5 to 6 days
23%*
3 to 4 days
*there is no compromise about the use of anesthetic medication
The participants also visited the rooms where
lithotripsy, cystography, changing the DJ or
nephrostomy catheter and prostate biopsy and
urodynamic examinations take place. The urological
polyclinic was also equipped with a cardiologic
consultation room with equipment for cardiac echo,
cardiac effort test, etc.
“On behalf of all the nurses who visited the hospital, I
thank the nursing staff and the head nurses of the
urology department for the very fine welcome we had
in San Raffaele,” said Vandewinkel.
New EAUN booth
This year’s EAUN meeting also featured a revamped
booth, which gave both members and non-members
the opportunity to inquire about membership
inquiries, future activities or simply have a meeting
place.
Nurses’ dinner
A special nurses’ dinner with music and an informal
atmosphere formed part of the social programme.
However, some were unable to attend since they were
unaware that registration for this event always takes
place online together with the meeting registration,
and is not automatically included in the registration.
All in all this year’s EAUN meeting was a success in
terms of attendance and quality of the programme,
and many of the participants said they look forward
to another instructive and insightful meeting in
Stockholm.
Next year’s meeting
The meeting in 2014 will take place from 12 to 14 April
2014, in Stockholm, Sweden. This year’s abstract
deadline will again be on the 1st of December (2013).
More information on the submission of a Difficult Case
or a Research Plan can be found on page 40 of this
newsletter.
The congress website www.eaustockholm2014.
org/15th-eaun-meeting/ with more information will
be available soon. We are looking forward to your
submissions!
March/May 2013
EAUN Fellowship addresses patient safety
Berne University Hospital hosts short-term visit
Kaija Tylli
Registered Nurse
Helsinki University
Hospital
Helsinki (FI)
comparing practice and procedures to those of a
hospital operating in a completely different
environment. As a renowned Swiss hospital, the
Berne University Hospital provided an ideal setting for
this comparative work.
[email protected]
Host institution
Berne University Hospital was founded in 1354. It is
named Inselspital and it provides highly specialised
medical care and has an international reputation of
being equipped with high-technology and engaging
in excellent scientific research. The hospital employs
over 7,100 people (Inselspital, 2012).
Helsinki University Hospital (HUCH) provides highspecialised medical care for more than a million
people within the Helsinki region. The coordination
of the service provision is divided between four
departments: Department of Medicine, Department
of Surgery, Department of Gynecology and
Pediatrics, and Department of Psychiatry.
The 17 HUCH hospitals form part of Helsinki and
Uusimaa Hospital District (HUS). HUCH hospitals serve
as training centers and provide excellent facilities for
both national and international research projects. As
of last year, the number of employees for the whole
HUS organisation totalled to around 21,322.
Inselspital has committed itself to a continuing and
long-term investment in nursing development and
research, and the strategy is to focus on Evidence
Based Practice (EBP) for at least the last 10 years.
(Willener, 2006).
The Department of Nursing Development and
Research has developed several standards and
strategies of different nursing interventions for the
whole organisation, and every clinic has adapted
them to their own speciality. All patient education
material is produced here. (Hirter, Shaha, 2013).
(39 beds), operating theatres, Intermediate Care Unit
(five beds) and a stone treatment centre (eight beds).
The Department of Urology has a Clinical Nurse
Specialist (CNS) who cooperates with the Department
of Nursing Development and Research and is
responsible for nursing development and nursing
quality within the clinic. The CNS has also been part
of research groups of the clinic. (Willener, 2013).
The Clinical Nurse Specialist organises education in
the clinic regarding current topics twice every month.
To share knowledge of experienced nurses with their
younger colleagues, additional short sessions (20
minutes) are organised in the ward. (Willener, 2013).
“The Department of Nursing
Development and Research has
developed several standards and
strategies of different nursing
interventions for the whole
organisation.”
effectively identify and implement relevant
procedures, every organisation needs dedicated staff
that has proper resources. One possible way to
support the implementation of evidence based
nursing practices is to have a separate department for
this. It provides a solid support for clinical work.
Once proper nursing practices have been identified,
their implementation in the daily work needs an
ongoing effort. Ideally, every clinic should have
dedicated staff for this type of work. The staff, e.g. a
Clinical Nurse Specialist (CNS), is important for all
aspects of nursing development and nursing quality.
The CNS is an important link between research and
development and the daily nursing practice: from
selecting the development topic to implementing and
evaluating it. The CNS could be used for nursing
consultancy or as a visionary of the future.
The latest strategies, evidence based nursing practices
and guidelines should be easy to find in the daily
practice. An up-to-date and structured Intranet is one
way of providing this important source. It serves both
the newcomers and the experienced nurses. It is also
important to have a continuing discussion about
clinical topics. These routine sessions will aid both
the newcomers and the experienced nurses, and the
goal of this developing work is that the nursing
practices will be solid and safe.
Before my visit to Berne I was in contact with the very
kind and experienced CNS Mrs Rita Willener, who
arranged me a versatile programme in the Department
of Urology. Mrs. Willener founded the Swiss Association
of Urology Nurses while being an EAUN board member. The above is supported by our own survey results.
She has really done a remarkable career.
(Tylli & Koskinen, 2012). Here one finding was that
newcomers found it difficult to get sufficient proper
Improving patient safety
information needed for decision-making in nursing.
I found my visit to Berne very rewarding and I learned
much about patient safety. In the following I list the
Even if patient safety thinking belongs to everyone in
All in all the team in Clinic of Urology consists of one
main points that I found during this project.
the organisation, it is important to have a separate
The Department of Urology in Inselspital (Fig. 1) is
professor of urology, 18 urologists, six senior residents internationally renowned for its surgical techniques in
unit for this. With is a systematic reporting and
(residents in urology), around three junior residents
evaluation system of adverse events and near-misses
treating bladder and prostate cancers. The Department A clear relationship has been demonstrated between
(residents in surgery), and 84 nurses, Last year, 2,392 of Urology consists of an Outpatient Clinic, two wards
inadequate nurse staffing and increase in e.g.
in place, patient safety can be improved.
elective urologic surgical operations were done in
mortality rates, urinary tract infections, pressure ulcers
addition to about 250 emergency operations.
and length of hospital stay. There are studies showing Acknowledgement
(Matikainen, 2012).
the improvement in quality of care and increase in job This visit was made possible with a grant of the
satisfaction following the implementation of the
European Association of Urology Nurses Fellowship
mandated ratios. (Berry & Curry, 2012).
My aim with this Fellowship short term visit is to
Programme.
improve the current patient safety culture and bring
concrete improvement proposals to daily practice and
Evidence based nursing is a type of evidence based
Note:
healthcare. It involves identifying reliable research
procedures. This work greatly benefited from
The references and an extended version of this article
results and implementing them in nursing practices.
are available on request at [email protected].
Figure 1: Clinic of Urology (Anna-Seiler Haus) at Berne
The aim is to provide the highest quality of patient
Please mention title, author and EUT edition March/
European Association of Urology Nurses
University Hospital.
care in the most cost-effective way. In order to
May 2013 in your email.
I work in the Clinic of Urology as a registered nurse.
The Clinic of Urology covers the entire range of adult
urology, from diagnose to high-specialised medical
care and follow-up. The clinic consists of two
Outpatient Clinics (in Meilahti Hospital and in Peijas
Hospital), three wards (48 beds), operating theatres
and a stone treatment center. I work mainly in the
urodynamic laboratory.
The Department of Risk Management organises patient
safety education for all of the clinics in Inselspital, and
there is a systematic reporting and evaluation system
of adverse events. The reports are mostly concerned
with medication. There is a system of emergency
notifications if an acute defect is noticed with products
or operation modes. These notifications are
immediately transmitted to the Intranet. (Paula, 2013).
A forward-looking urology practice
Report from Tauranga, New Zealand
Pene Meiklejohn
Manager, Urotech
Limited
Tauranga (NZ)
[email protected]
Tauranga City, located in the Bay of Plenty region on
the east coast of northern New Zealand, is one of the
country’s top holiday destinations, boasting one of
the sunniest climates and many beautiful beaches.
Tauranga is New Zealand’s sixth largest city with an
urban population of 122,000 encompassing 168
square kilometers. Around 17.4 % of the population is
over 65 and the Bay of Plenty region has an estimated
population of 214,910.
The management of the urological health budget is
unique in this region. Venturo is a joint venture
partnership providing elective urological services for
the Bay of Plenty. The joint venture partners are the
Bay of Plenty District Health Board and Urology Bay of
Plenty. Urology Bay of Plenty, in essence, is composed
of the four urology doctors in Tauranga. The clinicians
believed that they could provide a better and timelier
service if they managed the budget and deliver the
service in a different format compared to the previous
system.
European Association of Urology Nurses
March/May 2013
The concept is based on outcome rather than output
and all appropriate referrals were seen and treated
within a set timeframe and with very few exceptions.
Some of the factors that set Venturo apart from other
hospital-managed services are the categories of
referrals that are seen and treated within a fixed
timeframe of two months for a First Specialist
Assessment (FSA) and six months for elective surgery.
To demonstrate the efficiency, in 2011 there were 877
surgical urology procedures performed at the public
hospital wherein the urology team has three full day
lists per week. Obviously a dedicated and efficient
theatre team is available. The venture is now in its
18th year and has been at the forefront of health
delivery innovation. A neighbouring region, Waikato,
adopted this model soon after its development.
The founding urologists of Venturo, Peter Gilling and
Mark Fraundorfer, are internationally renowned for
their innovation, use of technology and clinical
research. This culture has been maintained with the
recruitment of urologists such as Andre Westenberg
and Liam Wilson.
Pioneering strategy
The pioneering nature of their business strategy is
also evident in their medical accomplishments and
opportunities. Tauranga has been the birth place of
numerous surgical procedures including the
invention of Holmium Laser Enucleation of the
Prostate (HOLEP) for BPH. Tauranga was the first in
the world to use Holmium for surgery, modifying and
developing techniques and equipment to suit the
HOLEP procedure. The first ever laparoscopic
pubo-vaginal sling was also performed here. Other
NZ first’s include laparoscopic prostatectomy,
laparoscopic nephrectomy, renal cryotherapy, prostate
cryotherapy, robotic prostatectomy and prostate aqua
ablation. The idea of using ultrasound for performing
TRUS biopsy came from Tauranga. Prior to ultrasound,
the needle guide was manually employed by the
doctor, meaning it was finger rather than ultrasound
guided.
Tauranga Urology Research Limited (TURL) was
established in 1992 by Gilling and Fraundorfer and has
experience in Phase I (first time ever in humans) to
Phase IV (variation to the license of an approved drug
etc) trials. The trials are single or multi-centre, pilot
and / or multinational studies and include
pharmaceutical and device studies. TURL employs a
manager and three part-time research nurses. Current
studies include metastatic prostate cancer, overactive
bladder, robotic prostatectomy, BPH, bladder cancer
and post-prostatectomy stress incontinence. A current
project is a Phase I study for BPH.
“...The first ever laparoscopic
pubo-vaginal sling...”
There are two hospitals in Tauranga, one public and
the other privately owned. The private hospital
(Grace) is owned and managed by Norfolk Southern
Cross Ltd, a partnership between two private
hospitals. Grace Hospital, which opened in 2007, has
six modern operating theatres, 50 inpatient beds and
a separate day-stay facility performing around 6,500
procedures per year. 30% of the Da Vinci robotic
prostatectomies that are performed at Grace are for
patients living out of the region. 70% of all
Brachytherapy Implants are also for out-of-region
patients. The publicly owned Tauranga Hospital has
349 beds including 224 beds which are available for
medical and surgical patients (including critical care
and coronary care). Tauranga Hospital has eight
operating theatres.
A committed partnership
There is a strong and committed relationship between
the urologists and nurses as we work together to
develop new techniques and procedures. The
teamwork also involves frequent development of care
plans, pathways, procedural setups and patient
information booklets for procedures that have never
been performed.
The urology nurses are appreciated and encouraged
to establish in-service and study groups; funding is
available for study and conference leave and
communication between the doctors and nurses are
informal and friendly. Generally, ‘Team Tauranga’ has
a strong representation at NZ Urology Nurse
Conferences.
Tauranga has hosted the annual National Urology
Nurses conference several times in the past decade
with the most recent in 2009 when 120 delegates
attended. These conferences are always a great
opportunity to showcase a region, network with
colleagues, establish friendships and be updated of
developments in other centres. Currently three of the
eight New Zealand Urology Nurses Society (NZUNS)
committee members are from this region, and I serve
as secretary and have been in the committee for five
years.
For me and many of my colleagues, urology work in
Tauranga is exciting, interesting, rewarding and
challenging. Come and visit us!
39
Join our search for Nursing Solutions in Difficult Cases
If you are among those who encounter atypical cases in daily practice and have
found your own solutions, we would like to invite you to take a few photos
and write a standard protocol. You can download a form with a list of standard
questions. The form should include a description of the problem, the nursing
intervention provided, the material you have chosen to help the patient and the
final results. Please note: Difficult Cases that have not been (completely) solved
may also be submitted!
Call for
Cases
Share your expertise
Together with the EAUN you will share and pass on this knowledge to other
nurses. The cases will be evaluated by an international expert jury. The 10 most
interesting cases are presented by the authors and discussed with the audience
in a special session at the 15th International EAUN Meeting in Stockholm. The
EAUN will place the material on their website as a unique opportunity to learn
from each other. All submissions that meet the criteria will be published on the
EAUN website and in European Urology Today.
Some of the Submission Criteria and Rules
• TheauthorsandpresenterofthisDifficultCasemustberegisterednurses
• Thetopicselectedmustbeofrelevancetourologynursinginterventionsin
Difficult Cases
• Thecaseisillustratedwithphotosoftheproblemandthesolution(ifany),
preferably 2-5 photos
• ThesolutiondescribedinthisDifficultCaseisyourownsolutionanda
nursing intervention
• Thecaseispresentedinacompletedsubmissionformaccompaniedbya
written patient consent
• WheninvitedtopresenttheDifficultCaseinStockholmyouwillpresentthe
case using the EAUN Difficult Cases slides
All criteria can be found at the Stockholm website:
www.eaustockholm2014.org/15th-eaun-meeting
How to apply
• PleasecheckthespecialpageonDifficultCasesubmissionatthecongress
website for full details.
• For more information you can contact the EAUN Office at [email protected]
Submission deadline: 1 December 2013
Nursing
Solutions in
Difficult Cases
Join our search for the best nursing solutions! We are looking forward to your
contributions!
European
Association
of Urology
Nurses
Nursing research may bring the most amazing results
With the EAUN’s commitment to support innovative work, we invite you
to submit a research project proposal for the EAUN Nursing Research
Competition.
During the 15th International EAUN Meeting in Stockholm (12-14 April 2014),
all projects of the nominees will be discussed in a scientific session, enabling
all participants to learn through feedback and discussions. A winner, chosen
from the six final nominees selected by a jury, will receive € 2,500 to (partly)
fund the research project.
The 10 best cases will be granted a free registration
for the 15th International EAUN Meeting in Stockholm,
12-14 April 2014
Call for Research
Projects
Eligible participants have to comply with the following:
• Onlyregisterednursescansubmitaresearchproject
• Theprojecthasnotstartedatthetimeofsubmission
• Theresearchandthepresentationhavetobedonebyanurse
• Thetopicselectedmustbeofrelevancetourologicnursing
• Theresultsoftheprize-winningresearchprojectwillbepublishedin
EuropeanUrologyTodayandontheEAUNwebsiteandthewinneris
invited to submit an abstract for the next International EAUN Meeting.
Consider the following guidelines before you start writing your research
protocol:
• Isyourresearchquestionclearandwhydoesitmatter?
• Howwillyouaddressthisquestion?(i.e.whatmethodswillyouuse?)
• Howimportantisthisactivitytourologicnursing?
• Areyourresearchmethodsappropriate?
All criteria can be found at the Stockholm congress website (from 1 May 2013):
www.eaustockholm2014.org/15th-eaun-meeting
How to apply
• Please check the congress website www.eaustockholm2014.org for full details.
• [email protected]
Submission deadline: 1 December 2013
We hope that you will not miss this opportunity. Remember, nursing research
small or large can still change the urological world!
EAUN Nursing
Research
Competition
€ 2,500 grant to be awarded at the
15th International EAUN Meeting
in Stockholm, 12-14 April 2014
40
March/May 2013

European Urology Today

Transcription

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