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European Urology Today
Official newsletter of the European Association of Urology 3
Vol. 26 No.5 - October/December 2014
How to serve as a peer reviewer
Record attendance for 6th EMUC
Infectious complication in prostate biopsies
A rewarding, fulfilling experience
More than 1,400 participants gather in Lisbon
Alarming rate of ESBL positive E. coli
Dr. Stephen Boorjian
5
7
Prof. Mete Çek
EMUC 2014 underscores challenges in onco-urology
Photography: Jack Tillmanns
Multidisciplinary Lisbon meeting aims to align key treatment practices
The EAU-ICUD Consensus Meeting takes a comprehensive look at current treatment options in onco-urology with the aim to provide recommendations.
By Joel Vega
Prospects and challenges are diverse in the
management of urological cancers prompting
onco-urology experts to identify key areas in the
diagnostics of these diseases and help boost current
efforts in aligning core treatment strategies.
This was one of the aims of the EAU-International
Consultation on Urological Diseases (ICUD) Consensus
Meeting held on November 13 in Lisbon, Portugal,
which preceded by a day the 6th European
Multidisciplinary Meeting on Urological Cancers
(EMUC) (See full EMUC report on page 5) and
coincided with the 3rd Meeting of the EAU Section of
Urological Imaging (ESUI) (Full report on page 11).
“Our aim was to provide an overview and
assessment of state-of-the-art systemic or medical
treatment of urological cancers and we were grateful
for the work of many experts from Europe and North
America. They have identified major areas, where
lies the challenges, which issues we can improve on
and draw more attention,” said Prof. Christian Stief
(DE), who co-organised the meeting in Lisbon
together with Christopher Evans (USA) and Karim
Fizazi (FR).
To come up with an inclusive and in-depth
assessment, 12 committees were created to examine a
wide range of diagnostic and treatment issues in
testicular, kidney, bladder and prostate cancers.
Prostate cancer has the most extensive coverage with
four committees investigating six areas such as
androgen dependence and castration resistance,
immuno- and gene-based therapies to cytotoxic
chemotherapy and targeted agents.
The meeting in Lisbon served as a preview to the
collaborative effort, which has the goal to eventually
publish in print and digital formats the collated views
and expert opinions on first-line and follow-up
treatments. Barring logistical and publication
requirements, and awaiting the final text refinements
of some committees, the plan is to release the
consensus report by March in time for the 30th EAU
Anniversary Congress in Madrid.
Renewed interest
Not only first-line but also follow-up targeted
therapies were taken up in renal cell carcinoma (RCC)
management. “There is renewed interest from
researchers in recent years in immunotherapy. There
is a doubling of abstracts at major conferences from
2009 and 2012. Approximately 800 clinical trials in
various phases are on-going in breast, colon, head
and neck, kidney cancer, etc.” said Allan Pantuck
(USA), a member of the committee on alternative
approaches in RCC.
"The meeting in Lisbon served as a
preview to the collaborative effort,
which has the goal to eventually
publish in print and digital formats
the collated views and expert
opinions on first-line and follow-up
treatments."
The discovery of a new class of drugs and checkpoint
inhibitors have given rise to this renewed interest,
and Cora Sternberg (IT) further described the
committee’s recommendations on medical
alternatives such as interleukin-2, interferon,
cytokines plus targeted therapies, immune checkpoint
inhibitors and therapeutic cancer vaccines.
“Regarding interleukin-2, high dose intravenous IL-2
is currently the only approved treatment for mRCC that
offers the possibility of long-term remission, but
should be used as first-line treatment only in carefully
selected patients,” said Sternberg. On cytokines
combined with targeted agents, the committee said
IFN with bevacizumab has yielded encouraging
results and remains a first-line treatment option for
kidney cancer patients.
Prostate cancer was thoroughly discussed with the
experts looking into the challenges and unresolved
issues in castration resistance, cytotoxic chemotherapy,
October/December 2014
immune-and gene-based therapies and androgen
pathway targeted agents, to name a few.
gemcitabine and MVAC, have an established role
both in metastatic and perioperative settings.
“Dendritic cell-based vaccines are promising but
challenging strategies,” said Charles Drake (USA) who
spoke on immunotherapy and other alternative
treatments. He said more work needs to be done in
the area of guidelines. Regarding DNA-based
vaccines, he noted the flexibility of this treatment as a
key attribute.
Anders Bjartell (SE) gave an in-depth overview of the
various issues in the chemotherapy of prostate cancer.
“Chemotherapy with docetaxel has been the first
treatment that provided an overall survival (OS)
benefit in metastatic castration resistant prostate
cancer,” said Bjartell. He added that taxanes exert an
AR-axis mediated anti-prostate cancer effect which
may be the background for future combinations with
other AR-directed agents.
On testicular cancer, Sophie Fosså discussed the
long-term adverse effects in testis cancer survivors
and said future research should examine how to
reduce late complications and the mechanisms
behind these adverse effects. Recommendations on
urothelial carcinoma of the bladder, meanwhile,
stated that cisplatin-based combinations, mainly
...there were also a lot of enthusiastic discussions...
“The meeting was not only well-attended, there
were also a lot of enthusiastic discussions. The
committee members presented concise reports and
data. What we have tried to achieve here in Lisbon
is not only to show the methodology but also to
provide practical recommendations and guidelines
for daily practice,” said Fizazi at the end of the
day-long meeting.
#EAU15
30th Anniversary EAU Congress
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20-24 March 2015
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Deadline: 12 January 2015
European Urology Today
1
Update from the EAU Guidelines Office
Dissemination: NGC, European Urology and Social Media
EAU Guidelines on NGC
Updated versions of three of the EAU Guidelines;
Paediatric Urology, Male LUTS and Trauma, have
recently been published on the National Guideline
Clearinghouse™ (NGC). These can be viewed here:
Paediatric Urology:
http://www.guideline.gov/content.aspx?id=47872
Male LUTS:
http://www.guideline.gov/content.aspx?id=48031
Trauma:
http://www.guideline.gov/content.aspx?id=48030
EAU Guidelines on Social Media
The Social Media Group are currently preparing to
post Guidelines communications using the EAU
Facebook: Like here: https://www.facebook.com/
EAUpage and Twitter accounts: Tweet @Uroweb:
https://twitter.com/Uroweb
Each panel chair has been contacted and asked to
nominate a panel member who will act as a liaison
with the Social Media Group, providing content from
their panel that deserves special attention and
dissemination to the urology community, such as
interviews and information from panel meetings.
This will be a highly engaging project and
collaboration and comments are gratefully
appreciated.
Publications
A systematic review by the EAU Muscle-invasive
Bladder Cancer (MIBC) Panel on the impact of
lymphadenectomy (LND) on oncological and
perioperative outcomes in patients undergoing radical
cystectomy (RC) for MIBC has recently been published
in European Urology. The panel reviewed 23 studies
reporting on >19,000 patients and found that any kind
of LND was advantageous over none in terms of
prolonged survival. However, it was evident that
quality of data was poor and there is a need for
higher quality studies.
European Urology Today
Read more on this interesting work here:
http://www.ncbi.nlm.nih.gov/pubmed/25074764
Editor-in-Chief
Prof. M. Wirth, Dresden (DE)
Guidelines Office Workshops
Following the recent changes to the Guidelines
(meaning that all of the Guidelines are based on
detailed and evidenced literature searchers), the
Section Editors
Prof. T.E. Bjerklund Johansen, Oslo (NO)
Mr. Ph. Cornford, Liverpool (GB)
Prof. O. Hakenberg, Rostock (DE)
Prof. P. Meria, Paris (FR)
Dr. G. Patruno, Rome (IT)
Dr. G. Ploussard, Paris (FR)
Prof. J. Rassweiler, Heilbronn (DE)
Prof. O. Reich, Munich (DE)
Dr. F. Sanguedolce, London (GB)
Special Guest Editor
Mr. J. Catto, Sheffield (GB)
Founding Editor
Prof. F. Debruyne, Nijmegen (NL)
Guidelines Office
European
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tter
Notification:
Adolescen
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of the Europe
an
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day
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of Urolog
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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
European Urology Today
Vol. 24 No.2
e for low-risk
A word of warning:
patients
Active surveillance
cancer and
the risk of overdiagnosis
on prostate
Prof. Chris
By Joel Vega
Promoting
your
meetings
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27th Annual
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- March/May
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links are
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on latest developments
for update
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e work is
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Further investments
colleagues
and specialists
in innovative
and urology’s
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from other
research studies
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disciplines,”
disciplines
with other
Japanese UrologicalKakizaki who co-chaired
remain
medical
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Association
that was reiteratedone of the key, overarching
Chris Chapple.
session with
by opinion
This year the
themes returned
Prof.
five-day 27th
leaders throughout
Japanese delegation
Annual EAU
the nearly in full force with more
February 24
Congress held
than 150
a year after
to 28 in Paris,
from
France.
prevented many the Fukushima calamityparticipants,
from attending
which
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Vienna.
the 2011 congress
lectured and
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spoke
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significant
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and surgical
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related Lower
of incontinence
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and
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Symptoms
congress provides
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together and
of
session collated attended meetings, the
evidence that
pursuing the
reporting
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ng
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topics.
Abrahamsson EAU Secretary
ceremony.
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during the
opening
With eight
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EAU
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on
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the second
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prostate cancer
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construction
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of stable blood
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said Wilt. He
did not reduce
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observation
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that exceeded
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in men
previous congresses.
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cancer. A potential with low PSA or low more than
plenary session
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exist in men
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PSA and possiblysurgery may
disease.”
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surgical procedures
bladder and
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personalised
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kidney surgeries.
in prostate,
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remarks
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session on
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Manfred
cancer
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studies on
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neoadjuvant
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the
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cancer detected
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medical or
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high
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rate of
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in uro-oncology
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and outside
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work within
l advances
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“Our participation
were discussed and the attendant myriad
here reflects
in the fourth-day
challenges
learning from
topics such
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plenary session
each other.
as the optimal
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if we expand
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my,
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of our
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py, benefits
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of simulation shock wave lithotripsy
AUA lecture
in surgical
training. The
on
Anthony Atala, regenerative medicine
given
Regenerative director of the Wake Forest by Prof.
Medicine,
Institute for
in tissue engineering, showcased the
current efforts
particularly
cells to create
biological substitutesthe use of stem
kidney, heart,
for the bladder,
liver and many
other organs.
“There are
still
resolve several challenges ahead…we
March/May
still need
issues in tissue
2012
engineering,” to
said
say opinio
n leaders
28th Annu
al EAU Cong
ress
www.eaumilan2
Editorial Team
H. Lurvink, Arnhem (NL)
J. Vega, Arnhem (NL)
L. Keizer, Arnhem (NL)
Guidelines Office Board are offering workshops to all
panels. The workshops will cover systematic review
methods as the backbone of guidelines production
and will discuss the upcoming projects of the panel.
The workshops will cover two days and are
013.org
European
Urology Today
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.
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.
1
coordinated by Prof. James N’Dow’s team from
Aberdeen University and Prof. Richard Sylvester.
The Bladder Cancer Panels recently had a successful
workshop and the aim is to complete these
workshops for all panels by mid-2015.
EAU Pocket
Guidelines App
FREE
for EAU
members
available now
in your Appstore
search for “EAU Pocket Guidelines” in your appstore
European Urological Scholarship
Programme (EUSP)
Do not forget to submit your online applications for Short Visit,
Clinical Visit, Clinical and Lab Scholarship, and Visiting Professor
Programme, before the next deadline of 1 January 2015!
For more information and application, please contact the EUSP
Office – [email protected] or check our website
http://www.uroweb.org/education/scholarship/
October/December 2014
How (and why) to serve as a Peer Reviewer Table of
Serving as a reviewer can be a rewarding, fulfilling experience
Stephen Boorjian,
MD
Professor of Urology,
Mayo Clinic
Associate Editor,
European Urology
[email protected]
mayo.edu
The currency of academics is peer-reviewed
publication. Publications form the basis for
communication of novel ideas and of research
findings, while facilitating practice improvement and
the expansion of knowledge.
tables and figures, which should add to the data
presentation rather than merely re-presenting
information provided in the text.
Introduction and Discussion sections
While not as critical as the Methods or Results
Sections, nevertheless, the text of the Introduction and
Discussion serve as an important backdrop for the
focus of the study. That is, the Introduction Section of a
manuscript should appropriately define topic of study,
should state the existing gap in knowledge which
makes the present study relevant, and should clearly
outline the hypothesis/question being investigated.
Meanwhile, the Discussion should (a) summarise the
critical findings of the manuscript, (b) contextualise
these findings in light of the existing literature on the
topic, (c) acknowledge the present study’s limitations,
and (d) offer next steps for research in the field.
Accordingly, an essential component of the publication
process is peer review, without which journal
publication would not be possible. Nevertheless, little
attention has been given to provide training on how to
perform a thorough and appropriate manuscript
review. Largely, a perfunctory literature review at
conferences/journal clubs comprises the extent to
which our trainees are exposed to the process of
critically evaluating a manuscript.
The importance of references
The References Section represents an absolutely
critical element of a manuscript, and should be
assessed in detail during a manuscript review. Why?
Appropriate referencing of the relevant literature on
the topic being presented reflects the authors
familiarity (and as such expertise) with the subject.
Are the most salient references on the topic included?
At the same time, given numerous competing clinical,
research, and teaching commitments, as well as the
challenge of maintaining work-life balance, the
relative value of serving as a journal peer reviewer
has been questioned.
Are the references timely? Look as well at the journal
source for the references. In addition, while some
degree of self-citation may be a result of the authors’
previous extensive work in the field, over self-citation
may be a problem.
Herein, an approach to performing effective
manuscript review is offered, as well as reflections on
the potential personal/professional benefits an
individual might enjoy by participating in this
time-honored and essential service.
Is the “devil in the details” – do the listed author
requirements for submission matter?
As with clinical practice, careful attention to detail
typically reflects quality work when it comes to
manuscript submissions. Thus, when reviewing a
manuscript, be knowledgeable about the journal’s
Tips for Effective Manuscript Review
guidelines (instructions for authors), and look to see
Assessing the manuscript title/abstract
whether the authors followed these. Was the abstract
Frequently, the casual reader will go no further than
structured according to journal specifications? Is the
the manuscript title and abstract. As such, these must word count in compliance? Were the references
provide an appropriate representation of the work.
formatted correctly? Do the numbers provided in the
One should determine whether the title accurately
text of the manuscript match with those provided in
represents the topic/findings being reported.
the accompanying tables/figures? While none of these
Moreover, the abstract should represent a “stand
features alone should form the basis for a decision
alone” element that contains the most important
regarding a manuscript’s disposition to accept/reject,
methodologic information and data from the
such factors do in fact reflect the authors’ level of
manuscript. In addition, the conclusions put forth in
vigilance, and thus should be considered and
the abstract should be supported by the data provided commented upon by the reviewer.
in the Results Section of the abstract, rather than
reflective of findings reported in the manuscript only, How to get better as a reviewer
which the abstract-only reader will not be privy to.
As with any new endeavor: practice, practice, practice.
Early on, accept review invitations whenever your
Methods and Results sections
schedule allows. By going through the process
These sections represent the most important
repeatedly, you will become more efficient and will
components of the manuscript, and should be the
sharpen your skills. In addition, follow-up on the
focus of the bulk of the reviewer’s time during
disposition of the manuscripts you are invited to
assessment of the manuscript. In the Methods
review – did the editor agree with your
Section, the reviewer should particularly evaluate
recommendations? What were the other reviewers’
whether the appropriate level of detail regarding the
comments? A great deal can be learned by seeing the
study population is provided (i.e. are inclusion/
manuscript through another reviewer’s commentary.
exclusion criteria clearly defined). Moreover, the
Don’t be concerned if your comments and/or
appropriateness of the methodology utilized to
recommendation disagree – more important is to gain
address the question of interest should be
what each of the other reviewers and editors took as
determined. That is, for example, if a study evaluated the “50,000 foot view” of the manuscript’s strengths
quality of life, the reviewer should particularly note
and weaknesses.
what instruments are being used, and whether these
represent validated measures. Likewise, for statistical
analyses, the appropriate use of Cox proportional
hazards regression models versus logistic regression
models should be noted. Whenever feasible,
standardised reporting guidelines should be utilised.
The Results Section of a manuscript, meanwhile,
represents central focus of the study, and should be
the section to which the reviewer is most careful in
evaluating. Herein, specific points for consideration
include the robustness of the dataset (i.e. number of
patients, number of events, duration of follow-up)
and completeness of reporting (i.e. do the authors
provide data on disease progression, cancer,
cancer-specific mortality, and all-cause mortality).
These measures should be contextualised within the
disease state being studied. That is, a three year
median follow-up would not be appropriate to assess
mortality following surgery for localised prostate
cancer, while three years would represent a
reasonable duration to report mortality following
cytoreductive nephrectomy for metastatic renal cell
carcinoma. Attention should be given as well to the
European Urology
October/December 2014
Benefits of Serving as a Manuscript Reviewer
Personal benefits
The critical elements discussed above to evaluate when
you are reviewing a manuscript are in turn the critical
elements to include when writing a manuscript. As
such, the practice of peer review will sharpen your
writing for subsequent independent manuscript
submissions. Through seeing what “works” (as well as
what doesn’t) in papers, investigators can significantly
enhance the quality of their own work. Moreover,
appropriately contextualising the data from a
manuscript under review, and being able to thereby
determine the novelty of the topic and findings being
reported, necessitates an understanding of the relevant
literature on the topic in question. In this process, one
gains an increased knowledge base that not only
further improves research activities but also enriches
one’s approach to clinical practice. Furthermore, by
serving as a manuscript reviewer, you are the “front
line” for what is often new data, and the opportunity
to get a first glance at such findings can be quite
exciting.
Professional gain
Young academic urologists often feel as if they toil in
obscurity, with the myriad of senior, established
colleagues making individual recognition difficult
early in one’s career. Providing high-quality reviews
in a timely fashion is one way to gain rapid visibility.
Editors quickly identify “go to” reviewers who, based
on their track record, can be counted on. These
individuals are often recognized by journals with
awards for their work, and/or are invited to contribute
review articles, and to join editorial boards. Thus,
quite rapidly junior faculty may be provided with
numerous opportunities as a direct result of their
work in the manuscript review process.
A rewarding service
In summary, the reviewer should consider four central
concepts when considering a manuscript: (1) the
originality of the topic, (2) the robustness of the
dataset, (3) the appropriateness of the methodology,
and (4) the importance of the findings. From these
four issues, the reviewer can provide to the editor an
assessment of whether the manuscript in question
adds in a meaningful and significant way to the
existing literature on a topic.
Manuscript reviewing is a voluntary service, which
may be time-consuming and, when starting out, even
overwhelming. However, with time and practice, one
can rather quickly become quite adept at performing
a thorough critical assessment of a manuscript.
Offered here are various insights to performing a
manuscript review, although it should be noted that
with experience one will undoubtedly develop an
individualized approach and many styles can be
equally effective.
The service though demanding can be quite
rewarding – through the process, you are contributing
to the very essence of academics, and have the
opportunity to view new data first and to improve
contributions to the literature. Young academics may
derive both personal and professional career
development. Most importantly, this should represent
an enjoyable and fulfilling compliment to one’s
clinical and research practice.
Contents
EMUC Meeting underscores challenges
in onco-urology. . . . . . . . . . . . . . . . . . . . . . . 1
Update from the EAU Guidelines office. . . . . . 2
How (and why) to serve as a Peer Reviewer. . 3
Clinical challenge. . . . . . . . . . . . . . . . . . . . . . 3
Record attendance for 6th EMUC edition. . . . . 5
EUREP section:
Enthusiasm and opportunities at the
12th EUREP. . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Honing surgical, medical skills in a friendly
environment. . . . . . . . . . . . . . . . . . . . . . . . . . 8
EUREP 2014: An investment in the future
of urology. . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Bringing resident training to another level. . . 9
An “Aussie” perspective on EUREP. . . . . . . . . 9
EBU section:
EBU Certified Residency Training
Programme in Urology. . . . . . . . . . . . . . . . . 10
Vall d’Hebrón University Hospital. . . . . . . . . 10
3rd ESUI Meeting: Insights and prospects
on urological imaging . . . . . . . . . . . . . . . . . . 11
Supple prescription rules in oncology
drugs in Italy . . . . . . . . . . . . . . . . . . . . . . . . 12
Infectious complication in prostate biopsies. 12
Key articles from international medical
journals. . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Obituary Aldo Vittorio Bono. . . . . . . . . . . . . 17
CEM Symposium report: BPH. . . . . . . . . . . . 18
14th CEM: Closing the gap between
East and West. . . . . . . . . . . . . . . . . . . . . . . . 19
10th SEEM reflects region’s growing role
in urology. . . . . . . . . . . . . . . . . . . . . . . . . . . 20
ESU section:
Comprehensive ESU course on male LUTS. . . 21
ESU-Weill Cornell Masterclass in historic
Salzburg. . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
ESU-Weill Cornell Masterclass in General
Urology. . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
ESU offers comprehensive course to
Armenian urologists. . . . . . . . . . . . . . . . . . . 23
Simulation fellowship: growth of a new
research field. . . . . . . . . . . . . . . . . . . . . . . . 23
ESUT section:
Masterclass in advanced 3D video-assisted
urological surgery . . . . . . . . . . . . . . . . . . . . 24
State-of-the-art urological surgery in
Heidelberg. . . . . . . . . . . . . . . . . . . . . . . . . . 25
4th International Course on Advanced
Laparoscopic Urology. . . . . . . . . . . . . . . . . . 25
Ten questions: Michael Jewett . . . . . . . . . . . 24
Global Action Plan on Active Surveillance
for low risk PCa . . . . . . . . . . . . . . . . . . . . . . 26
Book reviews. . . . . . . . . . . . . . . . . . . . . . . . 27
EULIS section:
Preventing stone migration during
intracorporeal lithotripsy . . . . . . . . . . . . . . . 28
EULIS launches new postgraduate
workshops on urolithiasis. . . . . . . . . . . . . . . 29
YUO section:
ESRU’s objectives in practice . . . . . . . . . . . . 30
The New Portuguese Residents Society. . . . . 30
An excellent training experience in Belgium. 31
ESUR Meeting examines research
prospects, challenges. . . . . . . . . . . . . . . . . . 31
Make fewer passes,
use fewer products,
and reduce costs.
Prostate stem cell research continues
hunt for genetic clues. . . . . . . . . . . . . . . . . . 32
EUSP Clinical Visit in Braga. . . . . . . . . . . . . . 32
EAU-RF: NIMBUS trial re-opens in
Germany, starts in The Netherlands . . . . . . . 33
EAU and partners: synergies. . . . . . . . . . . . . 34
Don’t forget to renew your EAU Membership!. 35
Congress calendar 2014/2015 . . . . . . . . . 36-37
Flexor Parallel
®
ERUS2014: Robotic Urology draws big
crowd to Amsterdam . . . . . . . . . . . . . . . . . . 37
™
R A P I D R E L E A S E ™ U R E T E R A L A C C E S S S H E AT H
MEDICAL
www.cookmedical.com
© COOK 2012
URO-BEMEAADV-FLPEUT1-EN-201212
EAUN section:
Nurses’ Programme at EAU Robotics Section
Meeting. . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
EAUN joins Chinese Urology Association
meeting. . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
15th Asia-Pacific Prostate Cancer Conference. 39
What to expect at the EAUN 2015 Annual
Meeting. . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
European Urology Today
3
Clinical challenge
Prof. Oliver
Hakenberg
Section editor
Rostock (DE)
The Clinical challenge section presents interesting or difficult clinical problems
which in a subsequent issue of EUT will be discussed by experts from
different European countries as to how they would manage the problem.
Readers are encouraged to provide interesting and challenging cases for
discussion at [email protected]
[email protected]
med.uni-rostock.de
Case study No. 40
This 74-year-old man, a retired general
practitioner, was referred by a nephrologist with
intermittent left lumbar pain and hydronephrosis
of the left kidney for three months. A degree of
renal failure had been known for several years,
current serume creatinine was 180 mg/dl. The
patient had been on antihypertensive treatment for
several years; current blood pressure was well
controlled. A renal scintigraphy showed reduced
overall renal function, with a
distribution of 80% to 20% for the
right and left kidneys, respectively.
A left retrograde ureterogram
showed marked medialisation of the
left ureter and a double-J stent was
inserted on the left side. A CT scan of
the abdomen was performed
(Fig. 1 and 2).
Discussion points:
1. What differential diagnoses should be considered?
2.Are further investigations needed?
3.What is the likely diagnosis?
4.Which treatment is appropriate?
Fig. 1 and 2: Abdominal CT scan
Case provided by Oliver Hakenberg, Department of
Urology, Rostock University Hospital, Germany.
([email protected])
A case of inflammatory aortic aneurysm
Comments by
David Castro-Diaz,
Santa Cruz de
Tenerife (ES)
The CT scan shows three main findings:
1. A non-dissecting aneurysm of the abdominal
aorta, with displacement of the abdominal
aorta to the left side;
2.A dilated left kidney with preserved
parenchymal thickness, suggesting an acute or
sub-acute rather than chronic cause such as a
renal artery aneurysm (stenosis or dissection);
and
3.A left ureter displaced medially with a ureteral
stent inside.
The presence of left hydronephrosis and medial
displacement of the ureter associated with aortic
aneurysm and urologic symptoms is typical of
inflammatory aortic aneurysm (IAA). This entity
represents 3-10% of abdominal aortic aneurysms
and in contrast to degenerative aortic aneurysm
(DAA), which remains asymptomatic until rupture,
the IAA usually presents with abdominal or
urological symptoms.
Abdominal pain is present in 85% and back pain in
55% of cases and it is associated with
hydronephrosis in 20-30% of patients. The latter
usually leads to deterioration of renal function,
eventually with elevation of serum creatinine. In
addition, 90% of patients have an elevated
erythrocyte sedimentation rate (ESR) indicating a
systemic inflammatory state.
There are several characteristic findings of this
condition to be seen on the CT scan such as
medialisation of the left ureter and four distinct
layers of the aneurysm: lumen, mural thrombus,
thickened aortic wall and associated fibrosis.
Furthermore, contrast injection shows increasing
density of the uniform periaortic inflammatory
layer. An MRI scan might provide further useful
information for the differential diagnosis, which
mainly is retroperitoneal fibrosis.
Medical treatment with corticosteroids is
controversial, and may be indicated in
symptomatic patients with an aneurysm size that
does not require surgery. The surgical treatment
of choice is challenging and would be the
retroperitoneal resection of the aneurysm instead
of a classical transperitoneal approach.
Immunosuppressive treatment for periaortitis
Comments by
Joachim Thüroff,
Mainz (DE)
This 74-year-old man has hydronephrotic atrophy
of the left kidney with a remaining split function of
20% on radionuclide testing. Despite left-sided
renal deterioration that has obviously been
ongoing for a longer period of time, clinical
symptoms of left flank pain are reported only for
the past three months. The left retrograde
ureteropyelogram (not provided) reportedly shows
medialisation of the left ureter.
The two presented coronar CT images after
placement of a double-j stent on the left side do
not allow formal exclusion of all possible
differential diagnoses of hydronephrotic atrophy of
the left kidney, such as decompensated UPJ
stenosis or an impacted ureteral stone. This is
firstly, because not all parts of the left collecting
system and ureter are visible on the two images,
and secondly, because the described
hydronephrosis of the left kidney is, at least,
partially relieved by the indwelling double-j stent.
However, these differential diagnoses are unlikely
since other pictures, e.g. of the retrograde study or
the CT scan, would have been provided in such cases.
Hence, the most likely diagnosis is retroperitoneal
fibrosis (Ormond’s disease), which characteristically is
associated with medialisation of the ureter. Since
retroperitoneal fibrosis has primary and secondary
forms, the pathology of the aorta, which is depicted in
Fig. 2, has to be discussed.
Concerning the etiology, the tissue augmentation of
the abdominal aorta is clearly located outside the
genuine aortic wall, which can be identified by
several small calcifications. In the literature, these
changes are described as “chronic periaortitis”, “giant
cell aortitis”, “coated aorta”, “Takayasu arteritis” and
“Horton arteritis” (1 – 5). The etiology of the aortitis
might be infective (mycotic, syphilitic) or – in the
abdominal location – predominantly non-infective,
non-syndromic of autoimmune nature or syndromic
such as associated with Erdheim-Chester disease or
histiocytosis X.
Treatment of the most common autoimmune type is
anti-inflammatory with cortisone and
immunosuppressive medication such as Azathioprin.
If ureteral obstruction does not respond to this
medication, surgical ureterolysis and entrapment of
the freed ureter into greater omentum or
peritoneum may be considered for a wellfunctioning kidney. However, a poorly functioning
kidney in a 74-year-old man, as in this case, might
be subjected to nephrectomy.
References
1. Svensson LG, Arafat A, Roselli EE, et al. Inflammatory
disease of the aorta: Patterns and classification of giant
cell aortitis, Takayasu arteritis, and nonsyndromic
aortitis. J Thorac Cardiovasc Surg. 2014 Aug 8. [Epub
ahead of print]
2. Vaglio A, Pipitone N, Salvarani C. Chronic periaortitis: a
large-vessel vasculitis? Curr Opin Rheumatol. 2011
Jan;23(1):1-6.
3. Tölle PA, Kesten F, Daikeler T. Giant cell arteritis
followed by idiopathic retroperitoneal fibrosis in the
same patient - an unexpected positron emission
tomography finding. Rheumatology (Oxford). 2012 Sep;
51(9):1549.
4. Chiba K, Kamisawa T, Tabata T, et al. Clinical features of
10 patients with IgG4-related retroperitoneal fibrosis.
Intern Med. 2013; 52(14):1545-51.
5. Dion E, Graef C, Haroche J, et al. Imaging of
thoracoabdominal involvement in Erdheim-Chester
disease. AJR Am J Roentgenol. 2004 Nov;183(5):1253-60.
Case Study No. 40 continued
The most likely diagnosis seemed
inflammatory aortic aneurysm with left
renal hydronephrosis. The patient was
treated medically with anti-inflammatory
drugs including corticosteroids and
continued left double-J ureteric drainage.
This led to improvement in symptoms and
renal function remained stable.
Improvement of the para-aortic
inflammation was also noted on follow-up
CT scans.
However, the patient complained of
continuing, and subjectively, very
bothersome symptoms related to the
double-J stent which had been changed at
regular intervals. He was offered
reconstructive surgery for the left ureteric
obstruction but instead he insisted on left
nephrectomy which was ultimately
performed.
Case study No. 41
Discussion points:
1. What type of injury is present?
2. Are further investigations needed?
3. What treatment should be done?
This 35-year-old man suffered a motorcycle
accident. There was a fracture of the right hand
and otherwise no bony injuries at all. He was seen
at Accident & Emergency where right flank pain
and some abdominal distension was noted. A
urinary catheter was inserted and marked
microscopic hematuria noted. The abdominal CT
scan is shown in Figures 1 and 2. There were no
other associated injuries except the hand fracture
and the patient was hemodynamically stable at all
times.
Case provided by Oliver Hakenberg, Department of
Urology, Rostock University Hospital, Germany.
Figures 1 and 2: Abdominal CT scan
4
European Urology Today
Readers are encouraged to provide interesting and
challenging cases for discussion.
October/December 2014
Record attendance for 6th EMUC edition
Focus on chemo-resistance, evolving drug landscape
By Joel Vega
With 1,456 participants from 66 countries, the 6th
European Multidisciplinary Meeting on Urological
Cancers (EMUC) held in Lisbon, Portugal from
November 14 to 16, marked the highest number of
attendance for the annual meeting which aims to
bridge the various treatment strategies by urologists,
medical oncologists and radio-oncologists.
“After seven years of holding this congress, we have
always focused on the central aim to foster education
and knowledge in urological cancer and improve
diagnosis and treatment through a multi-disciplinary
approach. Optimal treatment for cancer patients can
only be achieved if we continue with collaborative
activities such as the EMUC,” said EAU Secretary
General Per-Anders Abrahamsson (SE) in his opening
remarks.
Together with Joaquim Bellmunt (USA) of the
European Society for Medical Oncology (ESMO), Philip
Poortmans (NL) of the European Society for
Therapeutic Radiology and Oncology (ESTRO),
Gertraud Heinz-Peer (AT) of the European Society of
Urogenital Radiology (ESUR), and Antonio LopezBeltran (PT) of the European Society of Pathology
(ESP), Abrahamsson said the surge in attendance
testifies to the shared goal of onco-urology experts to
benefit from the synergies of collaborative work.
During the voting in the first plenary session around
46% in the audience were urologists, 21% radiooncologists, 15.6% medical oncologists and 0.6%
radiologists. Based on the initial survey voting, a
typical EMUC participant was academe-based (535),
either a staff member or consultant physician (93.6%),
based in Europe and a member of the EAU (42%).
The two-and-half day scientific programme examined
prostate, testis, penile, kidney and bladder cancers in
lectures, roundtable discussions, debates and
abstracts presentations. Hands-on training on
radiotherapy delineation contouring workshops were
also offered. For the first time, the EMUC was
preceded on November 13 by two simultaneous,
complementary meetings-- the EAU- International
Consultation on Urological Diseases (ICUD) Consensus
Meeting and the 3rd Annual Meeting of the EAU
Section of Urological Imaging (ESUI).
Progressing prostate disease
Prostate cancer (PCa) was the first topic in the plenary
session of the first day with a case presentation,
followed by lectures on imaging, treatment for
progressing PCa and a point-counterpoint
presentation on intermittent androgen deprivation
(IAD) versus continuous androgen deprivation (CAD)
in the treatment of castration-resistant prostate cancer
(CRPC). Maha Hussain (USA) argued for CAD while
Abrahamsson gave the opposing views in favour of
intermittent therapy.
Downplaying the benefits of IAD, Hussain examined
the strengths and weaknesses of major trials, survival
outcomes and quality of life (QoL) data, and said no
trial to date has demonstrated overall survival (OS)
superiority or equivalence of IAD over CAD. In her
concluding remarks, she compared CAD with IAD in
various disease settings.
Hussain said CAD has a role for the adjuvant setting
where survival can be prolonged with androgen
deprivation therapy (ADT) and local therapy.
Regarding non-metastatic PSA-only relapse, neither
approaches yield added benefit based on current
data, but for IAD, she noted: “There is possibly (a
role) but a balanced discussion is needed considering
the lack of data to support significant outcome impact
of either approaches.”
Abrahamsson, arguing for IAD, underscored the
discussion basically centres on the question whether
“to give more drugs or giving less drugs” while
noting that in maximal androgen blockade (MAB),
majority of trials are sponsored by industry compared
to a few trials for IAD. “There is no clear evidence for
inferiority or superiority of intermittent androgen
suppression (IAS) in terms of time to CRPC,” said
Abrahamsson as he insisted that IAD is equivalent to
CAD in selected patients.
IAD is effective as continuous ADT but with better
tolerability, according to Abrahamsson. “There is
insufficient data to determine whether IAD is able to
prevent the long-term complications of ADT,” he said.
”And more comparative analysis focused on QoL
issues is warranted.”
"Malignant and normal stem
cells possess multiple mechanisms
of resistance to radiotherapy."
- Norman Maitland
In the same session, Jelle Barentsz (NL) discussed
optimising imaging for biochemical recurrence,
Martin Gleave (CA) examined the natural history of
progressing PCa and whether treatment is always
needed, Marco Van Vulpen (NL) spoke on curative
radiotherapy for local recurrence, Steven Joniau (BE)
on curative surgery and salvage lymph node
dissection, and Gerhardt Attard (GB) on optimal
treatment for metastatic CRPC.
A few of their concluding remarks are:
• Van Vulpen on focal therapy: “Focal therapy
seems the best approach, but there are no large
series or long-term follow-up. In my opinion
what technique to use is not relevant, but quality
assurance is more essential.”
• Joniau on salvage lymph node dissection (LND):
“If salvage LND is considered, extended LND
templates are necessary, and for majority of
patients salvage LND will postpone hormonal
therapy and has limited toxicity.”
Chemoresistance in kidney cancer
The second half of the first day was largely focused on
renal cell carcinoma (RCC), testis and bladder cancer
with topics ranging from the role of LND in renal
surgery, new drugs in the pipline for RCC, checkpoint
inhibitors in onco-urology, the role of minimally
invasive radical cystectomy and management of
bladder cancer.
“Understanding and overcoming resistance is a major
challenge and drugs to overcome resistance are
needed,” he stressed.
Escudier enumerated several drugs being eyed as the
next generation in the fight against kidney cancer, the
13th most deadly cancer worldwide, and which
accounts for only 4% of all adult malignancies in
industrialised countries. However, kidney cancer kills
many since 3 in 10 patients present with metastasis at
the time of diagnosis. With a 25% mortality rate, it is
the most malignant of urological tumours.
October/December 2014
Drugs in development include
AZD-8055, Buparlisib, MK-2206,
GDC-0980/BEZ-235 and perifosine,
which are either in phase 1 or 2
studies. Regarding immunotherapy
Escudier said PD-1 blockade is a
strategy for immunotherapy, which
experts consider a promising option
in the coming years. “New targets
The 6th EMUC gathered the biggest attendance with more than 1,400 participants
are arising, cMET being the most
advanced one; targeted
immunotherapy is very promising, but
need to carefully select patients who can benefit from
‘when and how’ are the questions,” Escudier said.
radiotherapy,” said Huddart as he noted patients with
single, small tumours are suitable candidates.
Bladder cancer management
Heinz-Peer discussed imaging procedures in bladder
cancer and new approaches in the evaluation of
“There is a feeling that surgery is the only way to go.
haematuria, the strengths of new imaging techniques But if you have a proper discussion with patients,
radiotherapy can be an acceptable option to many, “
such as PET-CT and multi-detector computed
tomography urography (MDCTU), which provides high said Huddart during the Q&A and in response to a
query on why radiotherapy is not widely considered
quality multi-planar reformations (MPRs) and 3D
as an option in bladder cancer management.
reconstructions including virtual cystoscopic views.
Although MDCTU has excellent detection rates
including lesions less than 5 mm, it has low sensitivity Torben Orntoft (DK) discussed the translational
approach in bladder cancer. Among the core
for Tis/Ta lesions and does not provide biopsy,
challenges, Orntoft said are: identifying which tumour
will recur, how physicians can simplify the follow-up
In her concluding remarks, she noted the clear
advantage in using MDCTU and flexible cystoscopy as process, which tumour will progress, and in case of
muscle invasive cancers, which bladder tumours will
a triage test for rigid cystoscopy and follow-up.
Furthermore, the sensitivity of voided urine cytology is benefit from cystectomy and radiation therapy. He
discussed the work being done on surveillance
inferior to CT-ultrasound and flexible cystoscopy.
markers and expressed optimism current research
Carl Magnus Annerstedt (SE) discussed minimally
will eventually yield a considerable amount of
insightful data. “Genomic-wise, bladder cancer is a
invasive radical cystectomy such as robot-assisted
radical cystectomy (RARC), a safe procedure which
very complex disease. But we hope big data will be
coming,” he added.
yields similar results as open radical cystectomy. He
said intracorporeal diversion in RARC procedure is
truly minimal but stressed standardisation is
Best presentations
EMUC highlighted innovative research work, selecting
important in RARC.
the best unmoderated posters and the best oral
presentation. F. Al-Ubaidi (SE) won the first prize for
Regarding bladder preserving strategies, Robert
Huddart (GB) said radiotherapy has now wider appeal his study “Castration promotes radiosensitivity by direct
to patients who want to preserve their bladder and
regulation of DNA repair in prostate cancer.”
sexual functions. Moreover, elderly patients and those
Per-Anders Abrahamsson and his team (SE) took the
with co-morbidities have more benefits with
second prize for their work on “Disease characteristics
radiotherapy compared to surgery. “But there is a
influencing the duration of the off-treatment period
during intermittent androgen deprivation therapy with
degarelix in prostate cancer.” Third prize went to
W. Ong (AU) for the study, “Comparison of short term
oncological and functional outcomes between open and
robotic-assisted radical prostatectomy for localized
postate cancer in the Victorian prostate cancer registry.”
The best unmoderated poster prizes on Sunday went
to K. Izumi (JP) “The impact of androgen deprivation
therapy on bladder cancer recurrence: Retrospective
analysis,” (First Prize); V. Neiman (IL) won the second
prize for his study “Clinicopathologic factors associated
with the development of sunitinib induced hypertension
(HTN) in patients (pts) with metastatic Renal Cell
Carcinoma (mRCC),” and T. Yap’s (GB) study “Does
pelvic lymph node dissection have a role in the
treatment of penile cancer?” bagged the Third prize.
Michael Blute (USA) spoke on LND in renal surgery,
Bernard Escudier (FR) on new drugs for RCC, Joaquim
Bellmunt discussed checkpoint inhibitors, while
Heinz-Peer examined the various imaging approaches
in bladder cancer. On RCC, Escudier gave an overview
of new drugs and highlighted concerns about
chemoresistance.
“Although VEGF and mTOR inhibitors are still the
backbone of renal cell carcinoma (RCC) treatment,
new treatments are coming,” said Escudier. He,
however, cautioned that patients are developing drug
resistance.
Audience votes on treatment strategies
mentioned so-called inhibitor drugs
such as nintedanib, linifanib and
cediranib, which are currently in
phase 3 studies but with efficacies
that are still unclear.
“There are several categories with regards to new
drugs which target the VEGR/mTOR pathway, those
aimed to overcome resistance, and drugs for new
targets and immunotherapy,” said Escudier. He
Plenary session on castration-resistant prostate cancer
Bogdan Geavlete (RO) beat four other candidates to
win the first prize in the best oral presentations with
his study “The long term outcome of combined
NBI-plasma vaporization approach in large NMIBT
cases – a prospective, randomized controlled
comparison to the standard management.”
Selected key messages
• On Prostate Cancer: “Active surveillance (AS) should be regarded as a temporary but indispensable
solution for PSA screening related over-diagnosis and overtreatment. ” -Monique Roobol (NL)
• On Cancer Stem Cells: “Every human prostate cancer contains a therapy resistant, quiescent
population of stem-like cells…Malignant and normal stem cells possess multiple mechanisms of
resistance to radiotherapy. The stem cells are stimulated to amplify by our current therapies.”
-Norman Maitland (GB)
• On Immunotherapy: “Immunotherapy (Sipuleucel-T) has demonstrated effect on overall survival in
prostate cancer.” -Karim Fizazi (FR)
• On Small Renal Masses: “Percutaneous biopsy is safe and adequate cores have good diagnostic
yield and accuracy for diagnosis of malignancy.” -Alessandro Volpe (IT)
European Urology Today
5
ESOU15
12th Meeting of the EAU Section of Oncological Urology
16-18 January 2015, Munich, Germany
PRIME- approach to improve the outcome
of cancer treatment in uro-oncology
Known for its comprehensive and provocative discussion of uro-oncological issues, the ESOU
will present key updates and insights from Europe’s leading opinion leaders.
Presentations will not only include state-of-the-art lectures but they will also focus on pro
and- contra debates, panel discussions including multidisciplinary tumour boards and videos
demonstrating various surgical techniques in uro-oncology. Due to the broad spectrum of the
scientifi c programme, the ESOU meeting is the number one place to go for young urologists in
training, mid-career and veteran uro-oncologists to update their knowledge on the management
of patients with urogenital malignancies as well as in ongoing clinical and basic research
concerning urological cancers.
In addition we also have the STEPS programme (Sessions To Evalute ProgresS in the management
of urological cancers) which is now already in its fifth year. This innovative programme allows
a limited number of young academic urologists to meet established experts in the fi eld of
prostate, bladder and renal cancer. Application information will be distributed through European
academic centres. We would strongly encourage those that meet the selection criteria to apply
for this unique opportunity. Complementing the scientific programme we will also have handson training sessions for robotic assisted surgery. These sessions are always very popular but
remember places are limited. Aside from its goal to provide closer professional links among
Europe’s urological cancer experts, the ESOU also aims to help sustain the gains in urological
research, education and training.
Join us in Munich for yet another exciting ESOU event!
Open radical prostatectomy:
H. Lepor, New York (US)
Laparoscopic radical prostatectomy:
M. Colombel, Lyon (FR)
Robotic radical prostatectomy:
B. Rocco, Milan (IT)
08.30 - 08.40
Welcome
A. Heidenreich, Aachen (DE)
M. Brausi, Modena (IT)
08.40 - 09.00
Opening address
Personalised medicine to treat cancer –
already fact or still fiction?
R. Büttner, Cologne (DE)
12.40 – 12.55 Discussion
Prostate cancer I: Low Risk PCA and
active surveillance
Chairs: M. Brausi, Modena (IT)
A. Heidenreich, Aachen (DE)
14.00 – 16.00 Renal cancer: Localised and locally
advanced
Chairs: D. Jacqmin, Strasbourg (FR)
H. Özen, Ankara (TR)
Prostate Biopsy 2014: TRUS, MRI,
TRUS-MRI fusion via a transrectal or
transperineal route?
B. Djavan, Vienna (AT)
14.00 – 14.20 Management of the small renal mass
– reliability of renal biopsy
A. Volpe, Novara (IT)
09.00 - 12.55
09.00 - 09.20
12.55 – 14.00 Lunch
14.20 – 14.40 Discussion
09.20 – 09.30 Discussion
09.30 – 09.45 Molecular markers in the decisionmaking process of active surveillance
versus active treatment in low risk PCA
– are they ready to be used?
J. W. Moul, Durham (USA)
09.45 – 09.55 Discussion
09.55 – 10.10 Can multiparametric MRI alone identify
low risk PCA?
M. Emberton, London (GB)
10.10 – 10.20 Discussion
10.20 – 10.35 Follow-up of patients under active
surveillance: rebiopsy versus mpMRI
J. Hugosson, Gothenburg (SE)
10.35 – 10.45 Discussion
10.45 – 11.00 Coffee break
11.00 – 11.40 DEBATE: Phase to phase comparison of
PIVOT and SPCG-4
PIVOT trial: G. Andriole, St. Louis (US)
SPCG-4 trial: J. Hugosson, Gothenburg
(SE)
15 minutes each, 5 minutes rebuttal =
40 minutes
11.40 – 12.40 Radical prostatectomy in low/
intermediate risk prostate cancer
– how to achieve maximum cancer
control and best functional outcome
Moderators: M. Emberton, London (GB)
Y. Fradet, Quebec (CA)
6
European Urology Today
Ileal conduit
H. Abol-Enein, Mansora (EG)
17.00 – 18.00 Urothelial and bladder cancer II
Chairs: W. Artibani, Verona (IT)
Y. Fradet, Quebec (CA)
17.00 – 17.15 Long-term follow-up of orthotopic
neobladder in men: Oncological and
functional outcome
G. Thalmann, Berne (CH)
17.15 – 17.30 Pathology and management of non
urothelial bladder cancer
Y. Fradet, Quebec (CA)
17.30 – 18.05 Challenging cases of upper urothelial
cancer: Panel discussion
Moderator: YAU representative
Panel: H. Abol-Enein, Mansoura (EG)
Y. Fradet, Quebec (CA)
A. Stenzl, Tubingen (DE)
G. Thalmann, Berne (CH)
Saturday, 17 January
08.30 – 10.20 Prostate cancer II: Localised, high risk
Chairs: W. Artibani, Verona (IT)
M. Colombel, Lyon (FR)
08.30 – 09.10 Debate: Radical prostatectomy leads to
lower mortality rates than radiotherapy
D. P. Dearnaley, London (GB)
P. Sooriakumaran, Oxford (GB)
Scientific Programme
Friday, 16 January
16.30 – 17.00 Coffee break
14.40 – 15.10 Organ sparing surgery in central
tumours – is it feasible? (videos)
Open partial nephrectomy:
H. Van Poppel, Leuven (BE)
Laparoscopic partial nephrectomy:
J. Rassweiler, Heilbronn (DE)
Robotic-assisted partial
nephrectomy:
M. Roupret, Paris (FR)
15.10 – 15.20 Discussion
15.20 – 15.35 Management of local recurrences
following radical/partial
nephrectomy
D. Jacqmin, Strasbourg (FR)
15.35 – 15.45 Discussion
15.45 – 16.00 Achievements from the Corona
database
S. Brookmann-May, Regensburg (DE)
16.00 – 16.30 Urothelial cancer I: Multimodality
approach of bladder cancer
Chairs: A. Govorov, Moscow (RU)
A. Heidenreich, Aachen
(DE)
Interdisciplinary Tumour Board –
multimodality approach in reality
Urology: D. Pfister, Aachen (DE)
Radiation oncology:
M. Pinkawa, Aachen (DE)
Oncology: S. Wilop, Aachen (DE)
Radiology: C. Kuhl, Aachen (DE)
Pathology: R. Knüchel-Clarke, Aachen
(DE)
09.10 – 09.40 Debate: Adjuvant radiation therapy
following radical prostatectomy – do we
still need it?
Pro:
M. Bolla, Grenoble (FR)
Contra: W. Artibani, Verona (IT)
09.40 – 10.10 Debate: the role of choline/PSMA – PET/
CT in relapsing prostate cancer following
local treatment
Pro:
A. Briganti, Milan (IT)
Contra: J. W. Moul, Duke (US)
10.10 – 10.20 Discussion
10.20 – 11.20 Testicular cancer
Chairs: H. Ozen, Ankara (TR)
YAU Member
10.20 – 10.35
Active surveillance in clinical stage I
testis cancer: the new standard?
T. Tandstad, Trondheim (NO)
10.35 – 10.50 Long-term toxicity following systemic
treatment: what to expect, how to
monitor patients?
S. Gillessen, St. Gallen (CH)
10.50 – 11.05 Postchemotherapy RPLND – tricks of the
trade (video and presentation)
A. Heidenreich, Aachen (DE)
Orthotopic neobladder, open surgery
A. Stenzl, Tübingen (DE)
Robotic assisted orthotopic neobladder
C.M. Annerstedt , Copenhagen (DK)
14.00 – 16.00 STEPS (Session To Evaluate Progress)
programme
(closed programme: participation by
invitation only)
Led by Prof. M. Brausi, Modena (IT)
Sunday, 18 January
09.00 – 10.10 Management of postoperative functional
complications following radical surgery
in the small pelvis
Chairs: J. Hugosson, Gothenburg (SE)
F. Montorsi, Milan (IT)
09.00 – 09.20 Management of intraoperative
complications
H. Abol-Enein, Mansoura (EG)
09.20 – 09.40 Evaluation and management of erectile
dysfunction (including videos)
F. Montorsi, Milan (IT)
09.40 – 10.00 Evaluation and management of urinary
incontinence (including videos)
R. Bauer, Munich (DE)
10.00 - 10.10 Discussion
10.10 – 11.25 The Best of Uro-Oncology in 2014 – ESOU
Journal Club
Chairs: B. Rocco, Milan (IT)
A. Stenzl, Tübingen (DE)
10.10 - 10.25 Kidney cancer
TBC
10.25 - 10.40 Bladder Cancer
TBC
10.40 - 10.55 Testis Cancer
TBC
10.55 - 11.10 Prostate Cancer, localised and locally
advanced
TBC
11.10 - 11.25 Discussion
11.25 – 11.55 Coffee break
11.55 – 12.15 Award Ceremony
12.15 – 13.00 Prostate Cancer III: Metastatic and
castration resistant
Chairs: G. Thalmann, Berne (CH)
S. Gillessen, St. Gallen (CH)
12.15 – 12.30 Are there new concepts in first-line
treatment of metastatic prostate cancer?
TBC
11.05 – 11.20 Discussion
11.20 – 11.50 Coffee break
11.50 – 13.50 Urothelial cancer III: Muscle invasive and
advanced disease
Chairs: Y. Fradet, Quebec (CA)
A. Stenzl, Tübingen (DE)
11.50 – 12.20 Debate: Radical cystectomy and extended
pelvic lymphadenectomy: roboticassisted versus open surgery
Pro Open:
M. Brausi, Modena (IT)
Pro Robotic: P. Wiklund, Stockholm (SE)
12.20 – 13.50 How to avoid significant complications of
urinary diversion (video and discussion)
12.30 - 12.45 Sequencing of medical therapy in CRPC –
algorithm for clinical routine
S. Gillessen, St. Gallen (CH)
12.45 – 13.00 Options of palliative surgery in
symptomatic CRPC
D. Pfister, Aachen (DE)
13.00 – 13.15 Discussion
13.15
Close of the ESOU meeting
A. Heidenreich, Aachen (GER)
M. Brausi, Modena (IT)
Join the conversation at #ESOU15
Register now at http://esou.uroweb.org
Deadline: 13 January 2015
October/December 2014
MADRID
20-24 March 2015
30th
Anniversary
Congress
Sharing knowledge - Raising the level of urological care
Controversies and key issues in Madrid congress
Optimising your participation in EAU15
Prof. Morgan Rouprêt (FR)
Controversies in urology,
trends and new prospects in
treatment will be
highlighted in the plenary
and thematic sessions, live
surgeries, abstract
presentations, Joint and
Section Meetings that will
be presented during the
five-day 30th Anniversary
EAU Congress in Madrid.
Sessions, 10 Section Meetings and 11 joint EAU
meetings with national and regional societies, not
to mention the long list of poster and video
presentations plus courses organised by the
European School of Urology (ESU), among other
activities, will require congress participants to
select and prioritise their own interests.
“The Scientific Congress Office (SCO) decided to
introduce a bit more of controversies during the
plenary sessions especially regarding hot topics
such as the debate around robotics becoming a
new standard or the current limits of partial
nephrectomy, said Prof. Morgan Roupret (FR),
member of the committee which is responsible for
preparing the Scientific Programme.
Roupret provided some tips: “From a personal
perspective, it would be interesting to follow the
discussions on BPH and surgical laser therapy,
chemotherapy in treating urothelial carcinomas,
robotics in prostate surgery and its potential use
for lymphadenectomy, key findings from basic
research in polymorphism from kidney and
prostate cancer, and insights from molecular
mechanisms in bladder disability in neurogenic
patients.”
With the 30th anniversary and expectations of a
bigger attendance in Madrid, the SCO has carefully
selected prime topics and salient issues that
address the core of urological practice, research
challenges and the impact of emerging
technologies on medical treatment strategies. A
line-up of four Plenary Sessions, 19 Thematic
New findings from Magnetic Resonance Imaging
and its usefulness in the diagnosis (and staging) of
prostate cancer and ability to provide very
targeted, accurate and a limited number of
biopsies is another topic that will draw audience
interest. For participants tracking research
breakthroughs, Roupret mentioned findings on
PDL1 for bladder cancer, new androgen deprivation
and sequential treatment for prostate cancer,
chemosensitivity of urothelial carcinomas based on
histological variants and new insights regarding
male sexuality/QoL particularly in diabetic patients.
Responding to congress participants’ feedback, the
SCO has also made adjustments in the programme
such as extending the Thematic Sessions to 90
minutes to have more debate and input regarding
specific urological topics. Abstract sessions will
also be complemented with succinct summaries
from the session chairmen.
Regarding social media. Roupret encouraged
participants to use platforms such as Twitter.
“With Twitter one has the unique opportunity to
be in a room, while having the capability to
monitor what is going on elsewhere, and maybe
change rooms during simultaneous sessions.
Twitter is one of the best options if one wants to
be fully involved and reactive,” he said.
Tips on how to optimise your
Scientific Programme coverage
#EAU15
• Prepare for the congress in advance by looking carefully at the programme
• Attend the highlight session early in the morning to have an overview
of the best scientific data that will be presented
• Stay until Tuesday and attend the souvenir session with all highlights of the
EAU15 congress
• Download the EAU15 Congress App a few weeks before the congress on your
smartphone or tablet and build your own personal agenda or meeting planner
• Use social media such as Twitter to monitor topics that are generating extra interest
Morning sessions usually have intense discussions and debates that can prompt
insights and fresh ideas
Important dates
Check out the new
ew at
programme overvi
Congress participants are recommended
to avail of the advantages in completing
their registration ahead of the closing
dates. Please mark the following
important dates into your agenda!
rg
015.o
www.eaumadrid2
Early fee registration deadline:
12 January 2015
Late fee registration deadline:
9 February 2015
Live Surgery: prospects in
minimal invasive techniques
Reviewers to screen 4,272
submitted abstracts for Madrid
Monday programme for live surgical procedures
Many studies explore uro-oncology
Unlike in previous annual congresses when live
surgical procedures are held on a Saturday, the Live
Surgery programme in Madrid will be presented on
Monday, 23 March.
A total of 4,272 abstracts (including 297 video
abstracts) were submitted to the 30th Anniversary
EAU Congress to be held in Madrid, Spain, or 253 more
than the total abstracts submitted to the 2014 congress
in Stockholm.
To be organised by the EAU Section of UroTechnology (ESUT), in cooperation with the EAU
Robotic Urology Section (ERUS) and the EAU Section
of Urolithiasis (EULIS), the programme will start
right after Plenary Session 3, from 11.15 until 17.30.
Details of the programme are still under wraps
with the three section offices still finalising the list
of participants and procedures to be shown during
the day-long meeting. All procedures comply with
the strict regulations set forth in the EAU Policy on
Live Surgery. The policy has been approved by the
EAU Live Surgery Committee (ELSC) to ensure
patient safety, and is considered a pioneering
guideline of ethical requirements for live
surgeries.
ESUT has led the live surgery programme with the
aim to demonstrate an actual overview of the
prospects, challenges, best practices and technical
requirements in new minimally invasive techniques
in urology. In previous congresses the surgical
techniques ranged from robot-assisted procedures,
laparoscopy, robotic flexible ureteroscopy, or a
combination of novel techniques that have not yet
been adopted on a wide scale.
During the 2014 congress in Stockholm, among the
procedures that were shown were the use of
3D-HD-videotechnology for laparoscopy,
miniaturised instruments for laparoscopic and
endourologic procedures and image-guided
endoscopic procedures. Commentary and
questions from the audience also complemented
the sessions.
The ESUT surgeons and their collaborators from
the ERUS and ESUI are internationally renowned
experts who will serve as lead surgeons or
moderators during the live sessions. From the
participating hospital or expert centre, the live
surgery will be transmitted in real time via
high-definition and 3D quality video to a splitscreen that will allow the audience in the
auditorium to closely follow all surgical steps.
This year 278 reviewers will screen the 3,975 poster
abstracts submitted, a record number for the annual
congress. The reviewers will select at least 1,000
abstracts for presentation in Madrid, highlighting the
most innovative and thought provoking.
again actively participated this year with an even
higher number of abstracts.
Reviewers, however, will screen all submissions in a
“blind review” process focusing mainly on the
significance of the insights, the practical impact of
the study and the innovations introduced or being
pursued by researchers, among other considerations.
Prostate cancer treatment garnered the most interest
from researchers with 273 abstracts investigating a
range of treatment and diagnostic issues. Surgical
management of renal tumours was the topic in 195
abstracts, while 172 submissions focused on the
surgical treatment of urothelial tumours.
The abstract submissions came from 81 countries
from all over the world, with mainland
Europe, the Americas, Asia and the Middle East
among the most active regions. Abstracts actually
presented during the congress are eligible for the
prizes that will be granted to the best in two main
categories such as oncology, non-oncology, and
abstracts by residents and for the three best video
abstracts.
Similar to previous years, researchers in Europe
accounted for many of the submissions, with Italy
and Germany the most active in terms of submitting
their studies for critical review. Asian countries such
as Japan and South Korea have also increasingly
expanded their participation in recent years, and
The review will take place the whole month of
December 2014 and the accepted abstracts will
be made available on-line for EAU members one
month before the congress opens in Madrid.
General users will have access as of 20 March via the
EAU Resource Center.
EAU congresses and courses are accredited by the EBU in compliance with the UEMS/EACCME regulations
www.eaumadrid2015.org
October/December 2014
European
Association
European Urology Today
7
of Urology
EUREP2014
12th European Urology Residents
Education Programme
5-10 September 2014, Prague, Czech Republic
Enthusiasm and opportunities at the 12th EUREP
Participants and faculty commend comprehensive programme
With more than a decade in the frontline of
educating and training young urologists, the 12th
European Urology Residents Education
Programme (EUREP) this year received
commendations from participants and faculty
members for its comprehensive programme and
achievement to link veteran urologists with their
junior colleagues.
Held from 5 to 10 September this year in Prague,
Czech Republic, this year’s edition gathered 360
participants from 44 countries. Twenty faculty
members from across Europe led the five teaching
modules, together with experienced mentors for
the 10 hands-on training (HoT) sessions that is part
of EUREP’s core programme. The modules cover
the breadth of urology including uro-oncology,
prostate cancer and BPH, andrology, stones and
upper tract endourology, functional urology, and
paediatric urology, trauma and infection.
“The EUREP is known among young residents for
its inclusive approach, not only in the education
programme that emphasises practical insights with
sound theory, but also in its aim to foster
professional links among young urologists,”
according to the organisers.
With Profs. Hein Van Poppel (BE) and Joan Palou (ES)
as course directors, the annual programme is on its
second decade of providing both practical and
theoretical orientation to the scope of urology and the
challenges young doctors may encounter in actual
practice.
“The success of the EUREP programme really depends
on the interaction between the faculty and the
residents,” said Mr. Jay Khastgir (UK) who joined the
EUREP faculty for the first time this year. Khastgir
noted the friendly atmosphere the programme is
known for and said that this obviously prompted
young urologists to freely discuss with and inquire
from the faculty and experienced tutors.
In the HoT sessions, where 15 laparoscopy stations, 4
TUR and 3 URS were available, the one-on-one
mentored guidance was much appreciated by all
participants. “At the hands-on training sessions, it
was remarkable not only to have the time to improve
your skills but also to learn tips from experienced
This year’s ‘PERUE’ residents, part of the 360 residents from 44 countries
mentors,” said Dr. Katherine Henriquez from Panama
(See her full article on these pages).
“HoT is a winning and solid format, thanks to the hard
work by Ben (Van Cleynenbreugel) and the support of
Olympus. Everything went smoothly this year just like
in previous years. Our aim is now to bring the EUREP
hands-on training to the next level and this goal will
certainly require a lot of work from all those involved,”
said Dr. Domenico Veneziano (US), who succeeds Ben
as coordinator of the HOT programme.
E-BLUS exams were also offered this year, allowing
EUREP participants to further hone their laparoscopy
skills and take it to the next level. And following
EUREP’s social tradition, this year’s batch has to
formulate a name for their group, which often reflects
the casual if not bawdy humour of the residents.
Submitted by Dr. M. Sochaj, “PERUE” won the
selection, the acronym for ‘Powerful Experience of
Rapid Urological Education” and actually ‘EUREP’
spelled backwards.
Honing surgical, medical skills in a friendly environment
Dynamic faculty-residents discussions spur faster learning process
Mr. Jay Khastgir
Morriston Hospital
Dept. of Urology
Swansea (UK)
[email protected]
The EUREP is an excellent opportunity for urology
residents to update themselves in all the key areas of
urology in a six-day course, a programme annually
held in Prague, the Czech Republic, which is its
permanent venue.
The delegates rotate through five modules which are
designed as a series of interactive lectures and
discussions that address a specific area of urology
each day. This provides a comprehensive update of all
the key areas of urological practice. However, the talks
are not mere lectures or updates one would listen to
hear at scientific sessions of meetings. Instead, as an
active teaching programme, the discussions are
focussed on being interactive, which fosters learning
by direct involvement of the audience.
In addition there are excellent hands-on training
(HOT) sessions. The teaching is delivered by a
carefully selected faculty from several centres of
excellence, which effectively brings together a large
resource of experience and knowledge that urology
trainees can tap into. There is a social element to the
EUREP as well which enables professional
8
European Urology Today
networking. Although the obvious benefits of this
social interaction may not be immediately evident to a
resident, this will certainly become apparent in the
long-term. I am not aware of the existence of a
comparable course for urology residents elsewhere,
and it’s a testament to the EUREP’s success and
reputation that the programme is now being
emulated in some countries outside Europe.
Preparing for EUREP
Held since 2003, the EUREP is now in its second
decade. Although an ever increasing number of
residents apply each year, I would like to see it
become a course that all residents can attend. I
sincerely believe that those who did not attend during
their training have missed a valuable opportunity to
interact with, and learn from other residents and an
excellent faculty of experts. Consequently if you
haven’t attended the EUREP as yet, apply for it now!
To get the most out of the EUREP, residents should
review as many of the scheduled topics as possible in
advance, as this will lead to more insightful
discussions, reinforcing the participants’ current
knowledge and help clarify areas of uncertainty by
engaging in one-to-one discussions. The slides from
the previous year’s presentations are available online
and these provide a framework for the areas to be
covered.
The success of the EUREP programme derives from
the interaction between the faculty and the residents,
and although this is already superb it is an area
which we should continually try to improve. There are
several means of achieving this and one way is to
encourage residents to bring examples of difficult
clinical cases from their own practice for discussion
with the faculty, both at the formal sessions as well as
over lunch or coffee. The ability to apply the taught
information to their own real-life practice will foster
deep and long-term learning.
It was clear to me that the friendly and informal
approach of the faculty clearly helped many residents
realise that no question was too basic to bring up for
discussion, and this helped them overcome any
reservations they might have had, enabling them to
freely discuss difficult issues.
Functional urology
Regarding functional urology which I enjoyed being a
part of the faculty for, I found residents enthusiastic
and eager to learn as much as possible within the
time allocated to the module, and I was posed
interesting questions over coffee and lunch every day.
It is common for some residents to lack confidence
when dealing with various aspects of functional
urology. This is because often the diagnosis of various
functional conditions poses challenges which require
a logical approach not too different to that required
for solving a puzzle. From the discussions I had with
several residents, topics such as the role and
interpretation of urodynamics, the rationale for the
choice of management options for stress incontinence
and prolapse and the management of chronic pelvic
pain are common grey areas of uncertaintyconsequently trainees were grateful for the
opportunity to discuss such topics on a one-to-one
basis.
This probably reflects the inspiring teaching by my
colleagues as well as a realisation that the subject
requires analytical minds and a very different
approach than other aspects of urology.
Elevator pitch
Residents attending the EUREP have already chosen
their career path and consequently I don’t see them in
need of persuasion or so-called ‘elevator pitch’. All of
us who practise urology are aware that this very
interesting surgical speciality involves the diagnosis
and management of a vast range of pathology ranging
from various common and uncommon cancers,
functional and neurological disorders, and so much
more.
The rapid expansion in evidence base that underpins
our knowledge have now made it impossible for any
individual to know all the various aspects of urology
in great depth, which gives trainees the freedom to
choose from a wide range of subjects to subspecialise in or to remain proficient in, which includes
core aspects of urology. The use of ever-advancing
developments in technology keeps this speciality quite
literally at the cutting edge of medicine and makes it
both exciting and interesting.
In many countries the expanding ageing population
will guarantee that urologists will be kept busy.
Urology is well recognised as a ‘family friendly’
surgical speciality which allows improved work-life
balance, and this has attracted more female residents
to the profession in recent years. Most importantly,
the almost universal sense of humour that urologists
I certainly do think there was an increased interest in seem to possess guarantees a good working
functional urology among residents during the EUREP. environment in which to pursue a surgical career.
October/December 2014
EUREP 2014: An investment in the future of urology
Efficient organisation impresses young urologist from Panama
Dr. Katherine
Henriquez
Urology resident
Metropolitan Hospital
Dr. Arnulfo Arias
Madrid
Panama City (PA)
[email protected]
I first heard about EUREP a year ago from fellow
urology residents during my clinical visit at Fundació
Puigvert in Barcelona. Although they recommended it
as a useful tool for a review of urology with an
excellent faculty, I consider its value as a programme
that provides opportunities particularly for residents
who are training outside Europe.
I submitted my application eight months prior to the
programme, paying close attention to the
requirements for non-European residents and
taking into account that applications are screened for
the limited slots. Thus, when the acceptance letter
came, I was thrilled for having the privilege to
participate as a resident representative of Latin
America.
The organisers were efficient, quickly responding to my
queries about the registration and details of the event.
Study materials were accessible two months before the
course, and a schedule for the hands-on training and
European Basic Laparoscopic Urological Skills were
provided. With the efficient logistical information,
participants can prepare well ahead of time such as
reviewing the guidelines, studying the content of the
lectures, watching videos of endourological techniques
and training for the laparoscopic exercises using
simulators. Certainly, careful preparation is important
when joining this programme.
"...the extraordinary team of dedicated professors.."
At the hands-on training sessions, it was remarkable
not only to have the time to improve your skills but
I traveled from Panama to Prague with the best
also to learn tips from experienced mentors. The
disposition, and has resolved to continue learning and course has certainly succeeded in its aim to enable
training.
participants to consolidate and expand the
knowledge we have acquired during our resident
Intensive review
training.
In Prague, the participants went through six days of
intensive review of theory and updates on current
We also had the opportunity to exchange views and
urology. I have enjoyed the interactive clinical cases,
share experiences during the coffee breaks and make
the practical application of guidelines, and the
new friends at the social programme (BBQ/Karaoke)
opportunity to ask questions from expert lecturers.
where everyone had a great time singing and
dancing. Although the residents came from different
countries, we share the same dreams and concerns
regarding our future urological practice which, in
some ways, united us.
I’m thankful to the European Association of Urology,
the European School of Urology and the extraordinary
team of dedicated professors who have shown
outstanding work to make this programme a success.
Undoubtedly, the EUREP as a continuing medical
education programme is a worthwhile investment
with lasting gains that transcend cultural barriers.
Bringing resident training to another level
Training by experts mentors and unique social camaraderie
Dr. Anthony KallasChémaly
Department of
Urology
Hôtel-Dieu de France
Hospital
Beirut (LB}
[email protected]
yahoo.com
I first heard about EUREP from a colleague who
participated in the programme and I was encouraged
to apply for this year.
I continually invest in my learning and education by
reading articles in scientific journals such as the
European Urology, or by assessing my knowledge in
competition inspired me to improve my skills,
enabling me to win the first prize.
the MCQs and getting EU-ACME credits. I consider the
EUREP as another criteria which would offer me some
benefits, and I was therefore delighted when I
received an e-mail confirming my admission to the
EUREP.
The EUREP courses we attended were led by
well-known doctors and they were all very well
organized and structured in such a way that held our
interest and enthusiastic participation. It was a
pleasure to discuss clinical issues with the faculty due
to their insights and helpful tips.
Practising laparoscopy at a HoT session
EUREP is certainly a great opportunity to meet
urology residents from all over the world. It was
interesting to discover the differences and challenges
we encounter in both medical and surgical
managements. For my improvement and training, I
welcome and can see the benefits of new ideas. In
the social programme, the karaoke night was
certainly unique and special, a fitting occasion to even
get to know each other better.
Another beneficial feature of the course discussions
was the opportunity to debate or discuss in detail
about the cases during the coffee breaks, since the
participants are in a more informal and relaxed
setting, making the learning process less
intimidating.
Regarding the hands-on training (HoT) sessions,
I learned new tips and tricks in laparoscopy and
ureterorenoscopy. These sessions helped me a lot to
prepare for the E-BLUS exam which was also held
during the EUREP. Moreover, the Olympus endoscopic
For those who are interested, I can also give the
same recommendation and encouragement to
urology residents to participate in the EUREP, which to
me is one of the best opportunities for young
residents to improve their skills and bring their
training to another level.
An “Aussie” perspective on EUREP
Well-structured programme impresses USANZ representative
Deborah Klein
Education and
Training Manager
Urological Society of
Australia and New
Zealand
(USANZ)
[email protected]
usanz.org.au
I recently attended the 12th EUREP as a
representative of the Urological Society of Australia
and New Zealand (USANZ). The governing training
body (the Board of Urology) for urology residents in
Australia and New Zealand was interested in gaining
a detailed understanding of EUREP given its status in
the European education and training arena.
In particular, the Board of Urology was keen to
October/December 2014
improve the learning experiences for USANZ trainees
by benchmarking the USANZ Trainee Week Program
(an intensive five-day educational programme for
urology residents) with EUREP. Another aim was to
establish an open exchange of ideas and practices for
the benefit of both USANZ and the EAU.
number of delegates, it is clear that EUREP provides
an extremely worthwhile educational and social
experience for those who are fortunate to attend.
Their diligent attendance and participation at each
session (even after the late night karaoke party) is to
be commended.
I would like to express my sincere gratitude to Prof.
Joan Palou (Chair, ESU), Jacobijn Sedelaar-Maaskant
(Manager, ESU), Jacqui McGrath (Congress
Consultants) and the EUREP faculty for the wonderful
hospitality afforded to me during my stay in Prague. It
was an invaluable experience to observe all facets of
the programme, including the logistics, methods of
content delivery and methods for facilitating
participant interaction.
I was also particularly impressed with the dedication
(and stamina!) of the expert faculty. Their ability to
repeat presentations in their allocated module five
times over the week in a dynamic and engaging
manner was admirable. There was clearly a focus on
ensuring an optimal educational experience for all
participants and at times, modifications were made to
PowerPoint presentations or style of delivery based
on preliminary feedback from the daily evaluations.
New faculty members were also provided with
guidance and support from existing faculty members
on delivery techniques, sophistication of content,
methods of gaining delegate interaction and
presentation of clear and concise slides.
In my opinion, the programme is well structured and
truly provides a comprehensive update and overview
of current urological practice with particular reference
to the relevant EAU Guidelines. From speaking to a
Deborah Klein (R) with EUREP faculty member Vijay Ramani
I commend the EAU and, in particular, the European
School of Urology for their efforts in establishing
EUREP. It is an extremely valuable educational
initiative for urology residents and will continue to be
a rewarding experience for all involved.
European Urology Today
9
EBU Certified Residency Training Programme in Urology
Institute
Austria
Medical University of Graz
Landeskrankenhaus Leoben
University Hospital Salzburg SMZ Ost - Donauspital Vienna
Krankenhaus der Barmhezigen Brüder Vienna
Krankenhaus Hietzing
Wilhelminenspital der Stadt Wien
Belgium
Ghent University Hospital
Algemeen Ziekenhuis Groeninge in Kortrijk
University Hospitals Leuven
Croatia
University Hospital “Sestre milosrdnice” Zagreb
Czech Republic
Charles University Hospital Plzen
Charles University Hospital Motol
General University Hospital and Charles University
1st Faculty of Medicine Prague
Estonia
North Estonian Medical Centre Tallinn
Finland
Oulu University Hospital
Germany
Universitätsklinikum der RWTH Aachen
Klinik für Urologie und Kinderurologie Klinikum Bamberg
University of Bonn
Klinikum Braunschweig
Heinrich Heine University Düsseldorf
Universitätsklinikum Essen
Ev.-Luth. Diakonissenanstalt zu Flensburg
University Hospital Frankfurt
Klinikum Garmisch-Partenkirchen
Justus Liebig-University Giessen
Universitätsklinikum Halle (Saale)
Asklepios Klinik Barmbek Hamburg
Hannover Medical School
University Heidelberg
SLK Kliniken Heilbronn
Urologische Klinik und Poliklinik des Universitätsklinikums Jena
Klinikum Kassel GmbH
Universitätsklinikum Schleswig-Holstein, Campus Kiel
Malteser Krankenhaus St. Josefshospital Krefeld
Klinik für Urologie, Klinikum Ludwigsburg
Urologische Klinik, Klinikum der Stadt Ludwigshafen gGmbH
Klinik für Urologie, Universitätsmedizin Mannheim
Technische Universität München Klinikum rechts der Isar
University of Regensburg - Caritas St. Josef Medical Centre
Julius-Maximilians University Medical Center Würzburg
Programme Director
City
Prof. Dr. K. Pummer
Prof. Dr. T. Colombo
Prof. Dr. G. Janetschek
Dr. M. Rauchenwald
Dr. P. Schramek
Prof. Dr. H. Pflüger
Dr. N. Szabo Graz
Leoben
Salzburg
Vienna
Vienna
Vienna
Vienna
Prof. Dr. P. Hoebeke
Dr. I. Billiet
Prof. H. Van Poppel
Ghent
Kortrijk
Leuven
Prof. Dr. Davor Trnski
Zagreb
Assoc. Prof. M. Hora
Prof. M. Babjuk
Plzen
Prague
Prof. T. Hanuš
Prague
Dr. L. Kukk
Tallinn
Dr. P. Hellström
Oulu
Prof. Dr. A. Heidenreich
Dr. K. Weingärtner
Prof. Dr. S.C. Müller
Prof. P. Hammerer
Prof. Dr. P. Albers
Prof. H. Rübben
Prof. Dr. T. Loch
Prof. A. Haferkamp
Prof. Dr. H. Leyh
Prof. W. Weidner
Prof. P. Fornara
Prof. Dr. A. Gross
Prof. Dr. M.A. Kuczyk
Prof. Dr. M. Hohenfellner
Prof. Dr. J. Rassweiler
Prof. Dr. M.-O. Grimm
Prof. Dr. B.G. Volkmer
Prof. K.P. Jünemann
Dr. J. Westphal Dr. Med. A. Jurczok
Prof. Dr. M. Müller Prof. Dr. M.S. Michel
Prof. Dr. J.E. Gschwend
Prof. Dr. W. F. Wieland
Prof. Dr. H. Riedmiller
Aachen
Bamberg
Bonn
Braunschweig
Düsseldorf
Essen
Flensburg
Frankfurt am Main
Garmisch-Partenkirchen
Giessen
Halle
Hamburg
Hannover
Heidelberg
Heilbronn
Jena
Kassel
Kiel
Krefeld
Ludwigsburg
Ludwigshafen
Mannheim
München
Regensburg
Würzburg
Institute
Greece
Sismanoglio Hospital Athens
University of Crete
Hungary
Semmelweis University Budapest
Italy
General Hospital of Bolzano
Malta
Mater Dei Hospital
The Netherlands
Academisch Medisch Centrum Amsterdam
VU University Medical Centre Amsterdam
Norway
Sørlandet Sykehus HF Kristiansand/Arendal
Poland
Collegium Medicum Bydgoszcz
Holy Cross Cancer Centre Kielce
University Hospital in Kraków
European Health Centre Otwock
Pomeranian Medical University Szczecin
Specjalistyczny Szpital Miejski im. M. Kopernika Torun
Interdisciplinary Hospital Miedzylesie Warsaw
Medical University of Warsaw
Portugal
Coimbra University Hospital
Spain
Vall D'Hebron University Hospital Barcelona
Hospital del Mar (Parc de Salut Mar) Barcelona
Fundació Puigvert Barcelona
La Paz University Hospital Madrid
Cliníca Universidad de Navarra in Pamplona
Sweden
Urologiska Kliniken Universitetssjukhuset Örebro
Switzerland
University of Berne
Kantonsspital St. Gallen
Kantonsspital Winterthur
University Hospital Zürich
Turkey
Ankara University Medical Faculty
Hacettepe University, School of Medicine Ankara
Akdeniz University School of Medicine Uludag University in Bursa
Istanbul University Faculty of Medicine
Programme Director
City
Prof. C. Deliveliotis
Prof. F. Sofras
Athens
Heraklion Crete
Prof. I. Romics
Budapest
Prof. Dr. A. Pycha
Bolzano
Dr. K. German
Msida
Prof. Dr. T. De Reijke
Prof. Dr. E. Meuleman
Amsterdam
Amsterdam
Dr. A. Andersen
Kristiansand/Arendal
Prof. Z. Wolski
Prof. P. L. Chłosta
Prof. P. L. Chłosta
Prof. A. Borówka
Prof. A. Sikorski
Prof. T. Drewa
Dr. A. Antoniewicz
Prof. P. Radziszewski
Bydgoszcz
Kielce
Kraków
Otwock
Szczecin
Torun
Warsaw
Warsaw
Prof. A. Mota
Coimbra
Dr. J. Planas Morin
Barcelona
Dr. A. Francés
Barcelona
Prof. H. Villavicencio Mavrich Barcelona
Dr. F.R. de Bethencourt
Madrid
Dr. J.I.P. Piédrola
Pamplona
Dr. O. Andrén
Örebro
Prof. Dr. G. N. Thalmann Prof. Dr. H.-P. Schmid
Prof. Dr. H. John
Prof. T. Sulser
Berne
St. Gallen
Winterthur
Zürich
Prof. M.Y. Bedük
Prof. H. Özen
Prof. Dr. S.E. Guntekin
Dr. Y. Kordan
Prof. Dr. N. Aras
Ankara
Ankara
Antalya
Bursa
Istanbul
EBU Certified Sub-Speciality Centres
Programme Director
Prof. H. Van Poppel
Prof. D. De Ridder
Mr. J. Reynard
Prof. J. De La Rosette
Dr. C. Wagner
Institute
University Hospital Leuven (Belgium)
University Hospital Leuven (Belgium)
Oxford University (United Kingdom)
Academisch Medisch Centrum Amsterdam (The Netherlands)
St. Antonius Hospital Gronau (Germany)
Sub-Specialty
Oncology (Prostate, Kidney, Bladder)
Female & Reconstructive Urology
Stones Treatment
Stones Treatment & BPH
Prostate Cancer
Vall d’Hebrón University Hospital
Leading healthcare centre gains EBU certification
Dr. Jacques Planas
Morin
Vall d'Hebrón
University Hospital
Dept. of Urology
Barcelona (ES)
One of the main goals of the urology residency is to
educate residents for them to independently provide,
at the end of their training, comprehensive and expert
care to patients suffering from adult and paediatric
urological diseases. In addition, the programme
provides the opportunity for residents to engage in
research and teaching activities giving them a
foundation in these areas should they wish to pursue
a career in academic urology.
[email protected]
Vall d’Hebrón University Hospital, located at the foot
of the Collserola Hills in Barcelona’s northern district,
was founded in 1955. Today, it is the largest
healthcare, teaching and research complex in
Catalunya and one of the most important in Spain.
To achieve these aims, the full and part-time faculty
are committed to developing an organised
programme of diverse clinical activities, a rigorous
and comprehensive conference schedule, guidance
and support in clinical and laboratory research
activities, and supervision commensurate with the
resident’s level of ability in clinical patient care.
With over 1,100 beds, it is a multispecialty academic
medical centre that integrates clinical and hospital
care with research and education, working together
with the Universitat Autònoma de Barcelona, which
makes it one of the leading academic institutions in
Spain.
All residents may keep a logbook of surgical and
scientific activities. The logbook is presented to the
National Board of Specialities every year. Evaluations
(in which theoretical and technical aspects are
included) are fulfilled by the residency programme
co-directors after each resident rotation.
The Hospital Vall d’Hebrón Urology Department has
between 30 and 40 beds with a professional staff of
14 physicians representing all subspecialties of
urology. Over 2,000 surgical procedures, 100 kidney
transplants and 29,500 visits in the outpatient
department are performed annually. The Urology
Department covers the entire spectrum of the
speciality with an emphasis on uro-oncology and
kidney transplantation. Sub-speciality areas such as
BPH (laser surgery), Urodynamics and Female
Urology, Urethra and Reconstructive Surgery,
Urolithiasis, Andrology, Laparoscopy and Robotic
Surgery are led by experienced staff members.
The Urology Department chairman, the Hospital Vall
d’Hebrón Teaching Programme Director and the
Residency Programme co-directors meet once a year
to review the evaluations and individually assess the
progress of each resident. If the recommendation is
unanimous, a positive decision is taken and the
resident may continue his residency programme.
Resident Training Programme in Urology
The Urology Department is nationally accredited for
five years of clinical training. Two residents are
appointed each year, and eight residents are currently
in the programme.
EBU Certified Centres
10
European Urology Today
Residents may attend different weekly conferences
that are held in the Urology Department.
The following are the various types of conferences:
• Case conference: Cases refer to patients that are
scheduled to undergo surgery in the following
week. This conference is designed to prepare
residents for the oral board examination, provide
them the experience in presenting cases in an
organised manner, and enable them to use an
efficient approach in managing clinical problems;
• Renal transplantation conference: In cooperation
with Nephrology Department, this conference is
organized for a review of the medical history of
Full staff of the Urology department of the Vall d'Hebrón University Hospital
patients who are waitlisted for renal
transplantation;
• Journal club: Key articles from urologic literature
are reviewed by the faculty and residents;
• Urologic oncology conference: Attended by urology
faculty and residents, with members of the
Oncology, Radiotherapy, Radiology and Pathology
Departments. All problematic urologic oncology
cases are reviewed and recommendations are
made regarding patient management;
• Morbidity and mortality conference: Organized by
the chief residents who present all complications
recorded in the preceding month. Cases are
presented and organised by the residents.
Research
The Urology Department believes strongly in the
importance of research in advancing its goals. Located
near the Hospital Vall d’Hebrón are the Vall d’Hebrón
Institut de Recerca (VHIR) laboratories. The VHIR
laboratories are fully equipped for molecular biology,
biochemistry, genetics, and cellular biology research
and include facilities for tissue culture, animal
research, and immunohistochemical and in-situ
hybridization facilities. Residents are encouraged to
collaborate with investigators, provided they receive
adequate mentorship and support and perform
quality, hypothesis-based research related to a
urologic topic.
Residents are also encouraged to take an active part
in regional, national and international educational
courses and meetings, and the EBU In-Service
assessment. Although the EBU exam is not mandatory
to certify a Spanish urologist, we believe the
assessment is the best way to validate the residents’
knowledge and practical skills based on high
European standards. Our fifth-year residents attend
the EUREP course in Prague and participate in the
written part of the EBU exam.
We believe that the EBU certification we recently
gained is a mark of excellence and reflects our
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.
October/December 2014
3rd ESUI Meeting: Insights and prospects on urological imaging
ESUI holds well-attended meeting in Lisbon, Portugal
Dr. Jochen Walz
Chairman
EAU Section of
Urological Imaging
(ESUI)
Marseille (FR)
[email protected]
ipc.unicancer.fr
Leading European experts active in imaging and
image-guided treatment in urology gathered in
Lisbon, Portugal on November 13 for the 3rd Meeting
of the EAU Section of Urological Imaging (ESUI) which
was held in conjunction with the 6th European
Multidisciplinary Meeting on Urological Cancers
(EMUC).
With the aim to provide insights into the latest
developments for imaging especially in oncology, the
ESUI meeting organised a comprehensive programme.
The high attendance was beyond our expectations,
proving that combining an imaging and
multidisciplinary oncology meeting responds to the
needs of physicians active in urological oncology. The
programme also complemented the EMUC
programme, adding details about the value of imaging
in the management of urological malignancies.
individualised treatment and better disease
classification are among the major aims to address in
the future. Outstanding presentations examined
thematic blocs that prompted a lively interaction.
Participants went home with actionable take-home
messages, some of which are mentioned below:
Real-time tissue characterisation
One of the main observations regarding imaging in
urological surgery was the increasing possibility to
improve surgery by adding information gained from
imaging and by creating what is called augmented
reality. Several drugs and optical processing
techniques allow real- time information on tissue
function and tissue quality improving the safety and
outcome of surgery. Moreover, new navigational
computer systems and new imaging techniques such
as the DYNA-CT allow real-time 3D navigation during
surgery of renal masses or prostate cancer, providing
major potential for improvements of surgery in the
future especially when done by minimal invasive
surgical techniques.
Image-guided therapy of SRMs
This session provided valuable information on how a
focal therapy programme could be implemented in a
urological department. The European leaders in this
field gave tricks and hints to establish such
Representatives from the European Society of
Urogenital Radiology (ESUR) and the European
Association of Nuclear Medicine (EANM) also
participated. The overarching theme is that key
improvements in future cancer management will be
driven by better imaging. Providing better detection,
staging, and better follow-up and salvage treatments
will lead to improved and individualised treatment
strategies. During the EMUC it was also apparent that
EAU Section of Urological Imaging (ESUI)
Best Poster winner Tobias Maurer (Munich, DE), with Jochen
Walz, Manuel Ferreira Coelho and Dragos Georgescu
programmes and stressed that these programmes
require a multidisciplinary effort between urology
and radiology, as well as pathology. This concern
reflects the need for multidisciplinary meetings such
as the EMUC and ESUI meeting.
Joint ESUI and EANM
One of the meeting’s highlights was the joint meeting
between the European Association of Nuclear
Medicine (EANM) and the ESUI. The role of PET/CT in
the different urological malignancies was critically
assessed and clarified the value and limits of PET/CT
in managing individual pathology. There was a clear
consensus that such information is essential when
using this imaging tool in daily practice. Moreover, a
point-counterpoint discussion concluded that the
selection of the right patient with the right pathology
in the right clinical situation plays a crucial role to
improve the value of PET/CT as a diagnostic tool.
Best poster award
ESUI granted the prize for the best poster to Dr. T.
Maurer (Munich, DE) for his study entitled
“Preoperative lymph node staging of intermediate and
high-risk prostate cancer using whole body integrated
PET/MR with 68Gallium.lebelled ligand of prostatespecific membrane antigen.” The number of abstracts
submitted increased substantially and the quality can
be commended. We are confident that future
meetings will attract even more talented urologists to
submit their research on urological imaging.
Jochen Walz speaking at the Opening Session
There was unanimous agreement that standardisation,
training and quality control are mandatory and
essential before MRI or its alternatives (based on
ultrasound) could reliably be used on a large-scale in
daily practice outside specialised research centres.
Well-designed trials are also necessary to clarify the
real role of these tools and their potential in clinical
practice. Future developments such as dispersion
analysis for contrast enhanced ultrasound and
multiparametric ultrasound were presented.
The ESUI organised a very informative round-table
discussion with the industry to improve
communication and interaction between clinicians
and engineers. Such meetings are important since the
needs of urologists and radiologists can be conveyed
Advanced imaging in PCa treatment
Another highlight session was the imaging of prostate and joint efforts implemented to improve the quality
of care. With the value of round-table discussions, the
cancer (PCa), clearly the hottest topic in urological
ESUI will organise them as regular feature in future
imaging. The session opened with an excellent
meetings.
point-counterpoint discussion between Hashim
Ahmed (UK) and Alberto Briganti (IT) who took
With the success and the very positive feedback from
pro-con positions regarding focal therapy in PCa.
the participants, the 4th ESUI meeting is planned for
Currently available imaging tools for PCa such as
multiparametric MRI, elastography, contrast enhanced November 12, 2015 again in conjunction with the 7th
EMUC in Barcelona. Save the date and we hope to see
ultrasound ANNA/C-TRUS and HistoScanning were
you in Barcelona!
also critically assessed during the same session.
In 2015, join us
Down Under
www.erus15.org
ERUS15
12th Meeting of the
EAU Robotic Urology Section
15-17 September 2015, Bilbao, Spain
Robotic
Live
Surgery
EAU meetings
and courses
are accredited
by the EBU in
compliance with
the UEMS/EACCME
regulations
Abstract Submission Deadline: April 3, 2015
Featuring the SIU-ICUD Joint Consultation on
Image-Guided Therapy in Urology
www.siucongress.org
European
Association
A powerful resource for urologists
At your fingertips, anywhere, any time.
of Urology
October/December 2014
www.siu-academy.org
4133_SIU2015_EUT_Nov_Ad_v02.indd 1
Client:
SIU 2014
Description: GLASGOW SIU ACADEMY
Docket number: 24-4133
14-10-01 3:25 PM
European Urology Today
File Size:
Trim Size:
100 %
133,4 mm X 194,3 mm
11
Supple prescription rules in oncology drugs in Italy
Italian urologists can now prescribe abiraterone
Prof. Vincenzo
Mirone
Secretary General of
the Italian Society of
Urology
University Federico II
of Naples
Naples (IT)
that late-stage prostate cancer was not ‘hormone
refractory’ but ‘castration resistant,’ and in fact the
tumour was still dependent on testosterone but was
able to progress since it could get androgens from
elsewhere (perhaps even from the prostate cancer
itself). He also reasoned that adrenal insufficiency
would not be an issue with abiraterone, since
children born with inherited deficiency of CYP17 do
not suffer from it.
[email protected]
Abiraterone acetate represents a new therapeutic
weapon in managing men with advanced prostate
cancer who became castration-resistant. In 2012 it
was made available on the National Health Service
and transformed the options available for the 10,000
men each year who are diagnosed with aggressive
forms of prostate cancer.
Abiraterone was first patented in 1992 by the Institute
of Cancer Research of London. Early-stage clinical
trials in prostate cancer led by Professor Ian Judson,
with pharmacodynamic studies carried out by Dr.
Florence Raynaud, showed that abiraterone did hit
the correct target and lowered the levels of male
hormones. However, early in the drug’s development,
concerns were raised about the possible side-effects
of blocking CYP17 – in particular about the risk of
adrenal insufficiency. The developmental progress
was further hampered by a lack of interest in
hormone treatments for prostate cancer. Part of the
problem lay in the name of late-stage prostate cancer,
often referred to as ‘refractory’ disease, and scientists
and clinicians would argue that blocking androgen
production at a late stage would be ineffective.
But the skepticism surrounding the drug was
challenged when Professor Johann de Bono joined
the ICR in San Antonio, Texas, in 2003. Prof. De Bono
recognised the potential of abiraterone as a treatment
for men with advanced prostate cancer, and reasoned
In 2004 the first phase I study of abiraterone in
patients with advanced prostate cancer was run by
the ICR and The Royal Marsden. The small study
involved 21 men and found that the drug appeared
safe in humans and that majority of patients who took
it experienced both significant tumour shrinkage and
dramatic falls in PSA levels.
Significant benefits
Less than a year later, the results of a larger phase I/II
study were reported. This study of 54 patients
confirmed the phase I results, and showed that up to
70% of men responded to abiraterone. These men
experienced significant benefits for an average of
eight months, with scans showing their tumours
decreased in size and their PSA levels dropped
substantially.
"The ESOU Board updated the
current situation ... regarding the
prescription of oncological drugs by
urologists.."
Following these very positive results, the giant US
pharmaceutical company Johnson & Johnson agreed
to buy Cougar (the society which has the license to
abiraterone and owned worldwide exclusive rights to
develop and commercialise abiraterone) the royalties
for just under £600 million, gaining access to the
drug as it progressed through phase III evaluation. In
2010, a pivotal phase III trial showed that patients
given abiraterone lived on average 15.8 months
longer, compared with 11.2 months for men taking a
placebo. This part of abiraterone’s story exemplified
how basic molecular studies, followed by
collaborations between researchers, doctors and
industry, can lead to the successful development of
effective drugs that can transform lives.
Thanks to this strong clinical trial evidence for the
effectiveness of abiraterone, the ICR submitted a new
drug application to the US Food and Drug
Administration, leading to the approval of abiraterone
in the US.
Later in 2011, the European Medicines Authority also
licensed abiraterone. That opened the door to the
drug being made available in the UK, but accessing it
on the NHS continued to rely on local decisions by
primary care trusts, or access via the government’s
new NHS Cancer Drugs Fund. Abiraterone became
one of the most requested drugs on the Cancer Drugs
Fund, as anticipation grew that it would shortly be
accepted by NICE.
UK have the same rules wherein urologists cannot
prescribe pharmaceutical drugs. In Germany, Holland
and Belgium, urologists can prescribe all
pharmaceuticals. In Switzerland, new pharmaceuticals
for the kidneys and prostate can be prescribed;
however, chemotherapy drugs cannot be prescribed.
In Turkey, for kidney patients, urologists cannot
prescribe pharmaceuticals, while for prostate cases,
abi, enzalutamide and cabazitaxel can be prescribed
only by oncologists. Taxotere, on the other, can be
prescribed by urologists. In Spain and France,
urologists can prescribe pharmaceuticals (affirmation
from the staff of Sanofi).
Urology specialists, having their own walk-in clinics,
have a frontline role in diagnosis and are therefore
the first to be in contact with uro-oncological patients.
At the same time, they have been denied the
possibility of establishing a perfectly synergetic route
with the oncological specialist due to their inability to
prescribe oncological pharmaceuticals by oral means.
However, in February 2012, NICE announced its
rejection of abiraterone based on the high costs of the
drug unless more data are forthcoming or a better
price is offered. In May 2012, NICE and Janssen finally
reached an agreement over cost, and the drug was
made available on the NHS in England, Wales and
Northern Ireland. Since then, abiraterone has gained
a further licence for the treatment of prostate cancer
before chemotherapy, opening up the prospect that it
will be made available for even more men.
Considering the multidisciplinary rapport that is
strictly followed, administrative shortcomings, in
some cases, delay the therapeutic course of a
management strategy that is surely a disadvantage to
the patient who has paid the price for a breakdown in
communication. Representatives of the Italian
Association of Urology (SIU) and the national
regulatory organ AIFA met, and following in-depth
discussions, both institutions gathered and examined
the requests of urologists. Their goal was to
guarantee an improvement in managing patients with
prostate tumours.
Updating the guidelines
The ESOU Board updated the current situation (via the
country representations in the board) regarding the
prescription of oncological drugs by urologists. The
nations represented are Italy, France, the UK, Germany,
Russia, Turkey, Switzerland and Sweden. Italy and the
Starting last September 2014, when new prescription
guidelines were subsequently approved, urologists
can now administer oral oncological drugs. Today,
with the ability to prescribe abiraterone on the part of
urologist specialists, the gap in managing prostate
cancer patients has somewhat been filled.
Infectious complication in prostate biopsies
Alarming rate of Extended Spectrum Beta-Lactamase producing Escherichia coli in TRUS-guided biopsy
Prof. Mete Çek
Member EAU
Working Group on
Urological Infections
Edirne(TR)
[email protected]
Co-authors: Zafer Tandogdu, Tommaso Cai, Robert
Pickard and Truls Erik Bjerklund Johansen of the EAU
Working Group on Urological Infections.
Transrectal ultrasound-guided biopsy (TRUS-Bx) of
the prostate is a frequently used procedure for the
detection of prostate cancer. The main risk of the
trans-rectal biopsy technique is infective
complications including urinary tract infection (UTI)
and bloodstream infection.
The rate of these infections after was reported at 5%
in the Global Prevalence of Infections in Urology
(GPIU) Study1. A number of studies have shown that
fluoroquinolone-resistant microorganisms,
particularly Escherichia coli (E. coli), are frequently the
cause of these infections. More recently the
emergence of firstly extended spectrum betalactamase (ESBL) producing microorganisms and,
secondly, carbapenem-resistant organisms worldwide
is a major concern in this regard.
A multi-institutional study from Istanbul, Turkey
reported the prevalence of faecal carriage of ESBL
positive Escherichia coli in 400 patients undergoing
TRUS-Bx2. The investigators also searched for risk
factors for intestinal carriage of ESBL in this group of
patients, as well as reporting the prevalence of UTI
and infective complications following TRUS-Bx of the
prostate.
EAU Section of Infections in Urology (ESIU)
12
European Urology Today
A rectal swab culture performed in all men
undergoing biopsy showed that 19% were carriers of
ESBL E. coli in the faecal reservoir. The authors noted
that this high prevalence is one of the most important
problems together with resistance to
fluoroquinolones. They found that quinolone/
antibiotic use within the last two months, and DM are
risk factors for ESBL-producing Enterobacteriaceae
carriage before biopsy. In particular 20% of men had
received a treatment course of fluoroquinolones in the
previous two months.
Despite the isolation of E. coli in the urine of 13% of
patients on the third-day after biopsy, only 9%
suffered symptomatic UTI and repeat urine culture on
the 14th post-biopsy day showed no growth (Table 1).
Interestingly, ESBL E. coli carriage was not associated
with development of symptomatic UTI in the study
group.
Still, of the patients with UTI symptoms on the
post-biopsy third day, 68% were ESBL-PE carriers.
The authors suggested that the findings from their
study deserves attention by all those involved in
TRUS-Bx and further studies are needed concerning
prophylaxis protocols as well as management of
patients and TRUS-BX of the prostate. Investigation of
the high rate of usage of fluoroquinolones in the
community is also required.
However, given the limited range of antibiotics that
provide bacteriocidal concentrations within the prostate
(is) sufficient, there is limited scope to use alternatives
to fluoroquinolones for TRUS-Bx prophylaxis.
EAU Guidelines on prophylaxis before TRUS-Bx
suggest the use of fluoroquinolones, TMP ± SMX, and
possibly Metronidazole, leaving targeted prophylaxis
as an alternative. Single dose of one of these
antibiotics is considered to be effective in low-risk
patients. Prolonged course could be considered in
high-risk patients3. Individualised prophylaxis
approaches may prove to be more efficient and also
would be helpful in avoiding unnecessary antibiotic
consumption.
References
1) Florian M.E. Wagenlehner , Edgar van Oostrum, Peter
Tenke et al.: Infective Complications After Prostate
Biopsy: Outcome of the Global Prevalence Study of
Infections in Urology (GPIU) 2010 and 2011, A Prospective
Multinational Multicentre Prostate Biopsy Study Eur Urol
63(2013)521–527.
2) Tigen ET, Tandogdu Z, Ergonul O et al: Outcomes of Fecal
Carriage of Extended-spectrum β-Lactamase After
Transrectal Ultrasound-guided Biopsy of the Prostate.
Urology. 2014 Sep 17. pii: S0090-4295(14)00686-4. doi:
10.1016/j.urology.2014.04.060. [Epub ahead of print]
PMID: 25239255).
3) Grabe M, Bartoletti R, Bjerklund-Johansen TE et al:
European Association of Urology Guidelines on
Urological Infections, 2014.
[email protected]
com
Take control.
Table 1: Results of clinical follow-up of patients
undergoing TRUS-Bx of the prostate (modified
from Ref. 2)
Pre-biopsy fecal cultures 400 patients
ESBL producing bacteria 75 patients (19%)
Post-biopsy 3rd day
follow-up
289 patients
Post-biopsy 3rd day
urine culture positivity
39 patients (13%)
Post-biopsy 3rd day
symptomatic UTI
27 patients (9%)
Post-biopsy 14th day
follow-up
147 patients with no
symptomatic UTI or
positive urine culture
LithAssist
™
SUCTION CONTROL FOR LASER LITHOTRIPSY
For more information,
contact a representative or
[email protected]
MEDICAL
www.cookmedical.com
© COOK 2014
URO-BEMEAADV-LITHEUT-EN-201401
October/December 2014
EUREP15
13th European Urology Residents Education Programme
4-9 September 2015, Prague, Czech Republic
www.eurep15.org
Unique and exclusive training opportunity
General information
Participation and contribution
This teaching programme has been developed and
created exclusively for all European urological
residents. The EUREP provides an almost complete
update and overview of modern urological practice
presented by a distinguished European faculty.
The EUREP is an initiative of the European School of
Urology in collaboration with the European Board of
Urology. The written part of the FEBU exam (Fellow of
the European Board of Urology) will take place at a
later date in different cities throughout Europe.
Further information will be available on www.ebu.org.
Format
The format is a full six-day course comprising five
modules. Each day is made up of two sessions that
last around seven hours. Morning sessions feature
state-of-the-art lectures, while afternoon sessions
offer interactive case discussions, video, and
test-your-knowledge sessions.
The hands-on-training sessions will take place around
the modules. The training which is sponsored by
Olympus helps the participants sharpen their skills
and offers hands-on interaction with state-of-the-art
equipment.
Venue of the EUREP Meeting
The EUREP will be organised in Prague, Czech
Republic. The venue at the Clarion Congress Hotel
provides excellent facilities and the four-star hotel
has all the necessary facilities needed for both the
scientific programme and social activities.
Travel
Arrival date: Thursday, 3 September 2015
Departure date: Wednesday, 9 September 2015
after the modules end.
EUREP 2015 - Important
information for applicants!
From 2015 European participants in EUREP will no
longer have their travel costs reimbursed.
This means that all selected participants must pay
for their travel to and from Prague.
The EAU/ESU will continue to cover the cost of
accommodation for European residents in a
shared room as well as the cost of the course
(incl. lunches, coffee breaks).
Registration information
Important dates
Online registration opens on 6 January 2015. The
selection process will be made after the close of
registration on 1 May 2015. A total of 360
participants will be selected.
Participants will be notified by email if they have
been selected. If selected, the deadline for
cancellation is 1 August 2015 after this time a
cancellation fee of €500 will be charged.
Selection criteria
Registrations can only be submitted through the
online registration system. The registration will
only be considered complete if the registration is
accompanied by:
• A letter from the head of department
indicating the date that the participants
training will end
• A copy of your passport
Additional criteria
1. EAU membership. Priority is given to those
who are or become a member before the
registration deadline
2. Year of training. Priority is given to residents
in their final year of training (i.e. training
should be finished before September of the
following year based on the information
received from the proof of status)
3. It is required to obtain CME credits by
completing European Urology multiple choice
questions (MCQ’s). For further information
please check http://eurep.uroweb.org
4. First come – first served
5. English skills
6. Target per country
7. It is only allowed to attend the EUREP course
once
For further detailed information regarding the
registration rules for the 13th EUREP course we
strongly recommend that you visit
http://eurep.uroweb.org
Registration non-European residents
If you are a non-European resident that is
interested in taking part in the 13th EUREP
course please go to http://eurep.uroweb.org for
the rules and regulations regarding participation.
Preliminary programme 2015
Module 1 Urological cancer
Testis
Diagnosis & treatment of stage 1 disease
Management of metastatic disease
Penile cancer
Treatment of primary lesion
Management of inguinal lymph nodes
Urothelial cancer
Non-muscle invasive bladder cancer
Diagnosis, staging and risk stratification
Management of low, intermediate and high risk
disease
Muscle invasive bladder cancer
Surgical and non-surgical treatment options
Neo and adjuvant chemotherapy and the
management of metastatic disease
Upper urinary tract cancer
Renal cancer
Diagnosis and management of T1-2 disease
Management of locally advanced and metastatic
disease
Module 2 Prostate cancer and BPH
Prostate cancer
Screening, early detection and staging
Treatment for localised disease
Active surveillance, surgical treatment, radiation,
focal therapy
Locally advanced and metastatic prostate cancer
Treatment of castration resistant prostate cancer
and new agents
BPH
Medical treatment BPH
BPH: surgical treatment
Module 3 Andrology, stones and upper tract endourology
Andrology
Physiopathology diagnosis and treatment of
erectile dysfunction
Penile curvature
Priapism and metabolic syndrome
Male infertility diagnosis and treatment
Surgery for male infertility and vasectomy
Male hypogonadism
Stones
Aetiology, management and prophylaxis of
urolithiasis
ESWL treatment of urolithiasis
Percutaneous and open surgery
Upper tract endourology
Stents in the urinary tract
Ureteroscopic stone manipulation
Endourology in UPJ obstruction
Module 4 Functional urology
Essential terminology
Initial assessment
Fundaments of urodynamics
Stress urinary incontinence and pelvic organ
prolapse
Overactive bladder
Reconstruction and diversion
Assessing the neuropathic patient
General management of the neuropathic patient
Post-prostatectomy incontinence
Complex issues; pain, fistula and mesh exposure
Module 5 Paediatric urology, trauma and infection
Additional selection criteria!
Please be aware of the additional selection criteria that was introduced in 2014
(see registration information number 3)
Paediatric urology
Essentials of obstructive uropathy
Congenital malformations of the external genitalia
Infections
Urinary tract infections
Trauma
Diagnosis and management of kidney, bladder and
urethral trauma
“If you meet the criteria we would encourage you to register for this
opportunity, “ Prof. Palou, course director
Hands-on-training workshops
Participants can only participate in 1 session Lap
plus a TUR or URS. Places for URS and TUR are
limited.
Sharpening Your Skills: TUR, URS, and Laparoscopy
As an essential part of the European Urology
Residents Education Programme (EUREP) in
Prague, intensive hands-on training will be
delivered. This year's programme consists of
hands-on interaction with state-of-the-art
equipment in laparoscopy, ureteroscopy (URS) and
transurethral resection (TUR) -all of which sponsored
by Olympus.
laparoscopic suturing. Tutors will, of course, gladly
adapt tasks for more experienced individuals. Basic
techniques will be trained in a dedicated step-by-step
programme including intracorporeal suturing
depending on individual skill level.
The workshop provides the participants with a unique
opportunity to train basic techniques with complex
training models and under expert supervision. Thanks
to the intense tutoring scheme -with a personal tutor The training curriculum for the ureteroscopy
per training station- a fast learning effect can be
workshop is designed by Prof. Olivier Traxer of Tenon
expected.
Hospital, Paris. Residents will learn about the proper
use of flexible ureteroscopes using a variety of stone
The courses in laparoscopy are specifically designed
disposables in order to remove kidney stones.
for individuals with minimal or no prior experience in The course in transurethral resection of the prostate
gives residents the great opportunity to learn more
about the basics of high-frequency surgery, the
instruments needed, as well as tips and tricks for
daily surgery.
More information about the different training
modules can be found at http://eurep.uroweb.org
The hands-on-training workshops are sponsored by
an unrestricted educational grant from:
Scientific secretariat ESU Office
PO Box 30016 6803 AA Arnhem, The Netherlands
T +31 (0)26 389 0680 F +31 (0)26 389 0674
[email protected]
October/December 2014
European Urology Today
13
Key articles from international medical journals
Prof. Oliver
Hakenberg
Section Editor
Rostock (DE)
[email protected]
med.uni-rostock.de
Results of a randomised trial
in prostate cancer
Uncertainties about population screening, the risk of
over treatments and concerns about what is the most
effective management strategy led in 2001 to the
ProtecT trial. This aims to investigate the clinical- and
cost-effectiveness of active monitoring, external beam
conformal radiotherapy with neoadjuvant androgen
suppression and radical prostatectomy for men with
PSA-detected clinically localised prostate cancer. The
analysis of the primary outcome measure diseasespecific mortality at 10 years will not be available until
2016 but this paper presents the trial design and the
initial results of the PSA testing and diagnostic phase.
Designed in the late 1990s and opening in October
2001, this phase III trial invited 228,966 men between
the age of 50-69 years, to attend for screening.
100,444 (44%) attended their initial appointment and
82,429 had a PSA test. Previous PSA testing results
were checked in the medical record but were not an
exclusion criterion. Participants with a PSA of at least
3.0 μg/l were invited for digital rectal examination
and standardised ten-core transrectal ultrasound
guided prostate biopsy. Participants with a PSA of 20
μg/l or more were offered biopsy but excluded from
the study because of the high likelihood that they had
more advanced cancer.
Of the 8566 men with a PSA of 3.0-19.9 μg/l, 7414
underwent biopsies. 2896 men were diagnoses with
prostate cancer, 4% of the tested men and 39% of
those who had a biopsy. Of these 2417 had clinically
localised disease based upon assessment by DRE, and
isotope bone scan if the PSA was greater or equal to
10 μg/l or the Gleason score greater or equal to 7. MRI
for staging was used at the discretion of the
investigator. With the addition of 247 pilot study
participants recruited between 1999 and 2001, 2664
men were eligible for the treatment trial and 1643
agreed to be randomly assigned (545 to active
monitoring, 545 to radiotherapy and 533 to radical
prostatectomy). Median age 62 years with a median
PSA of 4.6 μg/l. Gleason score 6 in 1266 (77%) men, 7
in 339 (21%) men and 8-10 in 37 (2%) men. Clinically,
T1c in 76% and T2 in 24% of participants.
In men assigned active monitoring PSA was
measured every 3 months in the first year and twice
yearly thereafter. A rise of 50% or more over the
previous 12 months triggered repeat PSA within 6-9
weeks and if that remained elevated a repeat biopsy
was organised.
…ProtecT will provide data for the
comparative effectiveness of active
monitoring, radical prostatectomy
and radiotherapy…
In men receiving external beam 3D conformal
radiotherapy, neoadjuvant androgen suppression was
given for 3-6 months before and concomitant with 74
Gy in 37 fractions. PSA was measured every 6 months
for the first years and then annually. Biochemical
failure had occurred when PSA was 2 μg/l above the
nadir.
The majority of men receiving surgery underwent
open retropubic radical prostatectomy with bilateral
lymphadenectomy if the PSA was 10 μg/l or more or
the Gleason score at least 7. PSA was measure every 3
months for the first year, every 6 months for 2 years
and then annually. Adjuvant radiotherapy was offered
to those men with a positive surgical margin or
extracapsular disease. Biochemical recurrence
occurred when the PSA reached 0.2 μg/l.
As with many studies looking at localised prostate
cancer the treatments studied have evolved before the
Key articles
14
results are available and although 10-year data might
be available fairly shortly we may need longer
follow-up still to separate outcomes in this relatively
low risk group. Nevertheless, ProtecT will provide
data for the comparative effectiveness of active
monitoring, radical prostatectomy and radiotherapy,
which will be especially significant as other similar
trials did not complete randomisation
Vira MA, Turkbey B, Fakhoury M, Yaskiv O,
Villani R, Ben-Levi E, Rastinehad AR.
Source: Active monitoring, radical
prostatectomy or radiotherapy for localised
prostate cancer: study design and diagnostic
and baseline results of the ProtecT randomised
phase 3 trial. Lane, JA, Donovan JL, Davis M,
Walsh E, Dedman D, Down E, Turner EL, Mason
MD, Metcalfe C, Peters TJ, Martin RM, Neal DE,
Hamdy FC for the Protec study group.
In Europe it is estimated that 92,200 men a year die of
prostate cancer despite castrate levels of serum
testosterone. Disease progression remains dependent
upon androgen receptor (AR) signalling possibly as a
consequence of adrenal or intratumoural androgen
synthesis, increased AR expression and or constitutive
AR activation due to splice variants or activating
mutations.
Cancer 2014; 120: 2876-82.
More antiandrogens on the
way in prostate cancer
Lancet Oncol 2014; 15: 1109-18.
MRI versus risk calculator in
predicting significant prostate
cancer
Following the introduction of PSA testing there has
been a steady rise in the detection of clinically
insignificant prostate cancer (CaP) and subsequent
overtreatment. The Prostate Cancer Prevention Trial
risk calculator for high grade disease is a
multivariable mathematical model attempting to
predict the presence of clinically significant CaP.
Recent data suggest multiparametric magnetic
resonance imaging (mpMRI) has a high level of
sensitivity and a high positive predictive value for
identifying CaP. This paper compares the performance
of PCPTHG and mpMRI in identifying men at risk of
high grade or clinically significant CaP.
The analysis used data collected on men enrolled into
a phase III trial evaluating MRI/TRUS Fusion-guided
prostate biopsy (NCT01566045). Men with an
abnormal DRE of PSA level (> 4 ng/ml) underwent
mpMRI using a 3-Tesla MRI and an endorectal coil.
The images were reviewed by three radiologists who
graded all lesions that were suspicious for CaP on a
five-point Likert scale. Biopsy of suspicious lesion(s)
was performed using a proprietary MRI/transrectal
ultrasound fusion-guided prostate biopsy system,
after which 12-core biopsy was performed. A
genitourinary pathologist reviewed all pathology
slides. Because this was a comparison with results
from the PCPT, high-grade CaP was defined as a
Gleason score > 7, which was used in the
development of the PCPTHG. However, exploratory
analyses were performed using the Epstein criteria
for clinically significant CaP.
…mpMRI out performed PCPTHG
in predicting clinically significant
prostate cancer
175 men met the inclusion criteria and consented to
participate in the study. The overall cancer detection
rate was 64.6% (113/175) and 47.4% (83/175) had high
grade disease. Using the Epstein criteria, 82% (93/113)
of men diagnosed with CaP had clinically significant
disease. Age, abnormal DRE, PSA, PSA density,
prostate size, extraprostatic extension on MRI,
apparent diffusion coefficient value, and MRI lesion
size were identified as significant predictors of
high-grade CaP (all p < 0.05). The individual risk of
high-grade CaP was calculated using the PCPTHG
which suggested that the incidence should be 20.2%
compared with the observed 47.4%. However, the
AUC of PCPTHG and mpMRI were similar (0.676 vs.
0.769 p = 0.09). Nevertheless when clinically
significant prostate cancer was defined using the
Epstein criteria the AUC for mpMRI was 0.812 vs.
0.676 for the PCPTHG (p = 0.008).
Prof. Oliver Reich
Section editor
Munich (DE)
ODM-201 is a novel AR inhibitor which along with its
major metabolite ORM-15341 has a higher AR-binding
affinity than do bicalutamide, enzalutamide and
ARN-509. ODM-201 inhibits nuclear translocation of
AR in AR-overexpressing cells and significantly inhibits
tumour growth in the murine VCaP CRPC xenograft
model. Non-clinical data have also shown negligible
penetrance of ODM-201 through the blood–brain
barrier, thus suggesting a low risk of seizure.
ARADES was an open-label, multicenter trial in men
with progressive mCRPC. PSA progression was
defined as a rising PSA above 2 ng/ml in soft tissue
using the modified RECIST criteria or on bone scan by
the occurrence of 2 or more new bone lesions. In the
nonrandomized phase 1 dose escalation portion 24
men were treated with a daily doses of ODM-201 100
mg b.d. which was increased to 200 mg, 300 mg, 500
mg, 700 mg and 900 mg. Dose escalation was
discontinued because a maximum plasma
concentration was reached.
…ODM-201 had a favourable safety
profile and no seizures were noted
The phase 2 randomised dose expansion study
evaluated cohorts of approximately 35 patients at
doses of 100 mg b.d. 200 mg bd and 700 mg b.d. It
assessed the proportion of patients with a 50% or
greater decrease in serum PSA at 12 weeks. In the
phase 2 study patients were stratified by previous
exposure to both CYP17 inhibitor and chemotherapy.
[email protected]
uni-muenchen.de
Previous studies of donor or recipient origin of PTLDs
following solid organ transplantation have either
been small or with selected patient groups. In this
study, tumour origin in a population-based cohort of
93 patients with PTLD following organ transplantation
was studied. The tumour origin of PTLD tissue was
analyzed by fluorescence in situ hybridization of the
sex chromosomes in cases of sex mismatch between
donor and recipient (n = 41) or HLA genotyping in
cases of identical sex but different HLA type (n = 52).
The authors concluded that the
vast majority, if not all PTLDs, after
solid organ transplantation are of
recipient origin
With these methods, tumour origin of PTLD could be
determined in 67 of the 93 cases. All these 67 PTLDs
were of recipient origin. They were found in recipients
of kidney (n = 38), liver (n = 12), heart (n = 10) and lung
(n = 7). The most common recipient-derived
lymphomas were monomorphic B-cell PTLDs (n = 45),
monomorphic T cell PTLDs (n = 9), indolent lymphomas
(n = 6), and polymorphic PTLD (n = 4). Half of the
recipient-derived PTLDs were Epstein-Barr viruspositive. Twelve of the recipient-derived PTLDs were
located in the grafts: in four cases exclusively and in
eight cases in combination with disseminated disease
outside the graft. Tumour origin was indeterminable
in 26 cases, probably due to low DNA quality.
The authors concluded that the vast majority, if not all
PTLDs, after solid organ transplantation are of
recipient origin.
Source: Donor or recipient origin of
posttransplant lymphoproliferative disorders
following solid organ transplantation.
Kinch A, Cavelier L, Bengtsson M, Baecklund E,
Enblad G, Backlin C, Thunberg U, Sundström C,
Pauksens K.
During the study the most common treatmentemergent adverse events were fatigue or asthenia (15
of 124 (12%) men), hot flushes (6) and decreased
appetite (5). At 12 weeks 11(29%) of the patients in the Am J Transplant. 2014 Oct 10 [Epub ahead of print]
100 mg bd group showed a PSA response along with
13 (33%) in the 200 mg b.d. group and 11 (33%) in the
700 mg b.d group. Response was more marked in
Chronic allograft nephropathy
CYP-17 inhibitor-naïve patients.
Findings from this phase 1–2 analysis show that
ODM-201 has encouraging antitumour activity in both
chemotherapy-naive patients and chemotherapytreated men with metastatic castration-resistant
prostate cancer. ODM-201 had a favourable safety
profile and no seizures were noted despite the fact
that patients with a medical history of seizures were
allowed to enter the trial. These results support
further investigation of ODM-201 in a larger phase 3
trial in men with castration-resistant prostate cancer.
Source: Activity and safety of ODM-201 in
patients with progressive castration-resistant
prostate cancer (ARADES): an open label phase
1 dose escalation and randomised phase 2 dose
expansion trial. Fizazi K, Massard C, Bono P,
Jones R, Kataja V, James N, Garcia JA, Protheroe
A, Tammela TL, Eliott T, Mattila L, Aspegren J,
Vuorela A, Langmuir P, Mustonen, for the
ARADES study group.
Lancet Oncol 2014; 15: 975-85.
PCPTHG calculator has been limited by poor specificity
at high sensitivity. In this study, mpMRI out performed
PCPTHG in predicting clinically significant prostate
Post-transplant
cancer. Interestingly, only patients with a suspicious
lymphoproliferative disorder is
lesion on mpMRI were included and therefore it was
not possible to compare the detection of prostate
of recipient origin
cancer or the grade of cancer between those with and
Post-transplant lymphoproliferative disorder (PTLD) is
without a suspicious lesion on MRI.
a malignancy of lymphocytic origin typically occurring
only in recipients of solid organ transplantation. Its
Source: Multiparametric magnetic resonance
etiology is related to immmunosuppression but
imaging outperforms the prostate cancer
other than that little is known about the condition and
prevention trial risk calculator in predicting
clinically significant prostate cancer. Salami SS, its origin.
has a specific cause in many
cases
Chronic allograft nephropathy leads to late loss of
graft function. It is clinically common and accepted as
almost inevitable.
This paper examined the pathology of chronic
allograft failure, i.e. the relative impact of specific
versus nonspecific chronic histological damage.
All 1,197 renal allograft recipients who were
transplanted at a single center between 1991 and 2001
were included. All post-transplant renal allograft
indication biopsies performed in this cohort during
follow-up (mean, 14.5 ± 2.80 years after
transplantation) were rescored according to the
current histological criteria and associated with
death-censored graft outcome.
This study conclusively shows that
late graft loss is multifactorial
In the cohort, 1,365 allograft indication biopsies were
performed. Specific diagnoses were present in 69.4%
of graft biopsies before graft loss, but 30.6% of grafts
did not have specific diagnoses in the last biopsy
before graft loss. Only 14.6% of the patients did never
have any specific disease diagnosed before graft loss.
Extensive interstitial fibrosis and tubular atrophy
without a clear cause was identified as the single
EAU EU-ACME Office
European Urology Today
October/December 2014
Prof. Truls Erik
Bjerklund Johansen
Section editor
Oslo (NO)
[email protected]
cause of graft loss in only 6.9% of the cases. Acute
T-cell-mediated rejection and changes suggestive of
acute antibody-mediated rejection, diagnosed after
the first year post-transplant, were associated
independently with graft survival. Transplant
glomerulopathy increased over time after
transplantation and represented a major risk for graft
loss, as well as de novo or recurrent glomerular
pathologies and polyomavirus nephropathy.
Chronic histological injury was associated with graft
outcome, independent of specific diagnoses. This
study conclusively shows that late graft loss is
multifactorial. However, specific histopathologies are
common suggesting that specific treatment is more
often indicated. The conclusion must be that repeat
biopsies and treatment of concomitant specific
nephropathy might prolong graft survival.
Source: The histology of kidney transplant
failure: A long-term follow-up study. Naesens
M, Kuypers DR, De Vusser K, Evenepoel P, Claes
K, Bammens B, Meijers B, Sprangers B, Pirenne
J, Monbaliu D, Jochmans I, Lerut E.
Transplantation, 98(4):427-35, 2014
Is there an evidence-based
need for vaginal spheres
during pelvic floor muscle
training for urinary
incontinence?
Pelvic floor rehabilitation is the most common
first-line treatment for urinary incontinence in
females, before corrective surgery indication. This
training might be done alone or in combination with
other exercises, including electrical stimulation,
biofeedback techniques and/or use of vaginal
spheres. Vaginal spheres may improve the pelvic floor
musculature proprioception and may help the patient
to control his voluntary musculature. However, strong
level of evidence is not available regarding the real
benefit/risks from intravaginal medical devices.
This well-designed prospective
study shows that performing pelvic
floor exercises at home and without
supervision is improved by the use
of concomitant vaginal spheres
In the present randomized controlled trial, authors
compared twice daily Kegel exercises, five days a
week, over six months, alone (control group) or in
combination with vaginal spheres (treatment group).
Three Spanish institutions were involved and 70
women enrolled. Inclusion criteria were women of
35-60 years with mainly mild or moderate stress or
mixed urinary incontinence, who had delivered
vaginally at least once and had not previously
performed pelvic floor exercises. No medication
interfering with incontinence was allowed. The
primary and secondary endpoints were the ICIQ-UI-SF
score at the one hand, and the one-hour pad-test,
subjective efficacy and tolerance at the other hand.
Evaluation visits were planned on Days 7, 30, 90, 180.
Analysis between groups showed a statistically
significant improvement in amount of urine leakage
after three months. Within groups analysis revealed
an improvement in frequency and urine leakage since
one-month visit in treatment group versus six-month
visit in control group. Interestingly, women in the
control group did not improve their pad-test over six
months whereas a significant improvement was seen
in the treatment starting at one month and lasted
during the remaining follow-up.
Subjective efficacy assessed by investigators and by
patients was slightly improved in the treatment group
without statistical significance. Tolerance
(approximately 90%) and compliance (approximately
37% at the last visit) were comparable in both groups.
Key articles
October/December 2014
Tolerance improved throughout the study in both
groups whereas adherence decreased continuously.
delayed impact of solifenacin on continence return.
Several limitations can be highlighted. Some
important factors such as surgeon or surgical team
This well-designed prospective study shows that
experience, nerve-sparing surgery, pre-existing
performing pelvic floor exercises at home and without incontinence or detrusor instability that are strong
supervision for six months is improved by the use of
predictors of continence recovery, were not taken into
concomitant vaginal spheres. Beneficial results are
account. Moreover, concomitant use of pelvic floor
faster and better objective evolution was achieved
rehabilitation was not reported. Initial stratification by
regarding pad-test results over the treatment period.
storage symptom intensity or urodynamic
The lack of long-term follow-up may preclude strong investigations could be relevant to identify patients
clinically relevant conclusions as adherence to muscle who would benefit the most from solifenacin use.
rehabilitation decreases over time.
Moreover, such rehabilitation may not fit all because
about one-third of women are unable to contract
pelvic floor muscles. Another limitation of that study
was that both patients and therapists were not
blinded leading to potential interpretation biases.
Source: Effect of vaginal spheres and pelvic
floor muscle training in women with urinary
incontinence: A randomized, controlled trial.
Porta-Roda O, Vara-Paniagua J, Díaz-López MA,
Sobrado-Lozano P, Simó-González M, DíazBellido P, Reula-Blasco MC, Muñoz-Garrido F.
Neurourol Urodyn 2014 doi:10.1002/nau.22640.
Continence recovery after
radical prostatectomy: No
clear benefit favouring
solifenacin versus placebo
Even if the viability of external sphincter is the most
common factor of incontinence after radical
prostatectomy, bladder dysfunction after prostate
surgery may also influence urinary continence
recovery. Thus, control of detrusor instability by
antimuscarinics might improve return of continence.
Nevertheless, due to the lack of well-designed trials,
the EAU guidelines rank the evidence as C regarding
the use of antimuscarinics in patients suffering from
urgency or mixed urinary incontinence after radical
prostatectomy.
The present study was a phase 4, multi-center,
randomized, double-blind, placebo-controlled trial
assessing the impact of post-operative solifenacin in
the recovery of urinary incontinence after radical
prostatectomy. Enrolled men were those who were
still incontinent (defined by at least two pads per day
for seven consecutive days) seven to 21 days after
catheter removal. The primary objective was the time
to continence over a three-month study period.
Continence was defined by 0 or one pad for security
which remains completely dry. The secondary
endpoints were the proportion of men who gained
continence and the amount of daily pad use. Overall,
623 patients were randomized receiving 5 mg of
solifenacin or placebo. Solifenacin dose could be
doubled at week 4.
Regarding the primary endpoint, there was no
significant difference in the time to return to
continence between both arms, whatever the final
solifenacin dose (5 or 10 mg) used. Thus, the study
was globally negative. However, a slight but
significant improvement favouring solifenacin over
placebo was reported in the proportion of patients
continent at the end of the study (29% versus 21%,
p=0.04).
… no significant difference in the
time to return to continence between
both arms… however, a slight but
significant improvement favoring
solifenacin over placebo was
reported in the proportion of patients
continent at the end of the study
The number of pads per day was slightly improved
from week 12 in the solifenacin arm as compared with
placebo (p=0.01). In contrast, analysis of quality of life
outcomes and symptom scores did not show
differences between groups. Dry mouth was reported
in 6% of men receiving solifenacin (versus 0.6% of
placebo patients) without any difference in terms of
constipation rate between arms.
To recap, the use of solifenacin over a three-month
period does not globally improve time to continence
in men undergoing radical prostatectomy.
Nevertheless, analysis of survival curves that started
separating after 50 days, suggested a trend for a
Source: A Randomized, Double-Blind,
Solifenacin Succinate vs Placebo-Control Phase
4, Multi-Center Study Evaluating Urinary
Continence after Robotic Assisted Radical
Prostatectomy. Bianco FJ, Albala DM, Belkoff LH,
Miles BJ, Peabody JO, He W, Bradt JS, Haas GP,
Ahlering TE.
J Urol 2014 doi: 10.1016/j.juro.2014.09.106
Dr. Guillaume
Ploussard
Section editor
Paris (FR)
[email protected]
gmail.com
be informed about a possible time-dependent
alteration in functional results at the time of surgery.
Nevertheless, only few patients required surgical
re-treatment during the first five years after initial
surgery.
Source: 5-Year Longitudinal Follow-up after
Retropubic and Transobturator Midurethral
Slings. Kenton K, Stoddard AM, Zyczynski H,
Albo M, Rickey L, Norton P, Wai C, Kraus SR,
Sirls LT, Kusek JW, Litman HJ, Chang RP, Richter
HE; Urinary Incontinence Treatment Network.
Higher long-term success rate
but greater negative impact
J Urol 2014 doi: 10.1016/j.juro.2014.08.089
on QOL after retropubic-sling
compared to transobturator- Factors affecting
sling for stress urinary
spermatogenesis upon
incontinence
gonadotropin-replacement
therapy
Failure rates increase over time after surgery for
stress urinary incontinence. Whereas outcome
equivalence has been demonstrated when comparing
retropubic and transobturator slings, few long-term
well-designed studies have characterized five-year
equivalence between the two devices.
Whereas authors … reported higher
success rates after retropubic-sling,
subjective assessment revealed
that women felt better after
transobturator-sling surgery
Kenton et al. reported in this article the five-year
outcomes of a randomized equivalence clinical trial of
retropubic and transobturator midurethral slings.
Treatment success was defined by the absence of
re-treatment for stress urinary incontinence and no
self-reported stress urinary incontinence symptoms on
questionnaire. Satisfaction, urinary symptoms, quality
of life and adverse events were also reported. The two
previous publications from this trial concluded that
objective success rates met the criteria for equivalence
at 12 months but no longer met these criteria at 24
months. Overall, approximately two-thirds of women
initially enrolled were followed at least five years and
included in this observational study.
Regarding the primary endpoint, treatment success
was 8% greater after retropubic compared to
transobturator sling (51.3% versus 43.4%). As
difference did not reach statistical significance,
success rates could not be considered different from
one another. However, rates did not meet prespecified criteria for equivalence. Reasons for failure
were incontinence symptoms in 85% of cases, and
surgical re-treatment in 14% of cases.
Interestingly, urgency incontinence symptoms and
incontinence negative impact on QOL were greater in
the retropubic-sling arm (p=0.001 and p=0.02)
compared to transobturator-sling. Moreover, mean
sexual function scores were lower in the retropubic
group (p=0.001). In line with these significant
differences regarding the secondary endpoints,
women receiving transobturator-sling felt more
frequently “very much better” or “much better” than
women receiving retropubic-sling (p<0.0001). Overall
satisfaction rate did not differ between both groups.
No significant difference in terms of serious and
non-serious adverse events was reported.
This study is highly interesting and reveals that
objective success rate should not be regarded as the
only gold standard endpoint in incontinence
treatment trial. Whereas authors were unable to
attest to the long-term equivalence of both devices
and reported higher success rates after retropubicsling, subjective assessment revealed that women
felt better after transobturator-sling surgery thanks
to lower urgency rates and improved sexual
function.
In line with two-year outcomes, failure rates
increased over time highlighting that patients should
The authors performed a meta-analysis to
systematically analyse the results of gonadotropin and
GnRH therapy in inducing spermatogenesis in
subjects with hypogonadotropic hypogonadism (HHG)
and azoospermia.
An extensive Medline and Embase search was
performed including the following words:
'gonadotropins' or 'GnRH', 'infertility',
'hypogonadotropic', 'hypogonadism' and limited to
studies in male humans. Overall, 44 and 16 studies
were retrieved for gonadotropin and GnRH therapy,
respectively. Of those, 43 and 16 considered the
appearance of at least one spermatozoa in semen,
whereas 26 and 10 considered sperm concentration
upon gonadotropin and GnRH, respectively.
The combination of the study results showed an
overall success rate of 75% (69-81) and 75% (60-85)
in achieving spermatogenesis, with a mean sperm
concentration obtained of 5.92 (4.72-7.13) and 4.27
(1.80-6.74) million/mL for gonadotropin and GnRH
therapy, respectively. The results upon gonadotropin
were significantly worse in studies involving only
subjects with a pre-pubertal onset HHG, as compared
with studies involving a mixed population of pre- and
post-pubertal onset [68% (58-77) vs. 84% (76-89),
p = 0.011 and 3.37 (2.25-4.49) vs. 12.94 (8.00-17.88)
million/mL, p < 0.0001; for dichotomous and
continuous data, respectively].
…gonadotropin therapy, even with
urinary derivatives, is a suitable
option in inducing/restoring fertility
in azoospermic HHG subjects
A similar effect was observed also upon GnRH. No
difference in terms of successful achievement of
spermatogenesis and sperm concentration was
found for different FSH preparations. Previous use of
testosterone replacement therapy (TRT) did not
affect the results obtained with gonadotropins.
Finally, a higher success rate was found for subjects
with lower levels of gonadotropins at the baseline
and for those using both human chorionic
gonadotropin and FSH.
The authors concluded that gonadotropin therapy,
even with urinary derivatives, is a suitable option in
inducing/restoring fertility in azoospermic HHG
subjects. Gonadotropins appear to be more
efficacious in subjects with a pure secondary nature
(low gonadotropins) and a post-pubertal onset of the
disorder, whereas previous TRT does not affect
outcome.
Source: Factors affecting spermatogenesis
upon gonadotropin-replacement therapy:
A meta-analytic study. Rastrelli G, Corona G,
Mannucci E, Maggi M.
Andrology. 2014 Nov;2(6):794-808. doi: 10.1111/
andr.262. Epub 2014 Oct 1.
EAU EU-ACME Office
European Urology Today
15
Dr. Francesco
Sanguedolce
Section editor
London (UK)
[email protected]
hotmail.com
Link between lifestyle and
health factors and severe
Lower Urinary Tract Symptoms
(LUTS)
Despite growing interest in prevention of lower
urinary tract symptoms (LUTS) through better
understanding of modifiable risk factors, large-scale
population-based evidence is limited. The authors
intended to describe risk factors associated with
severe LUTS in the 45 and Up Study, a large cohort
study. A cross-sectional analysis of questionnaire data
from 106,435 men ≥ 45 years, living in New South
Wales, Australia was performed.
culture.
There were 7,728 consecutive patients included in the
analysis, whose data were prospectively recorded. On
the other hand, the data were pooled and analysed
retrospectively to answer the study question.
The authors reported as main
findings that administration of
antibiotic prophylaxis differed from
13% to 100%…
There was a substantial disproportion between
patients who received an antibiotic prophylaxis prior
a URS (group 1 = 82.8%) and those who did not
(group 2 = 17.2%); most of the patients of the latter
group where recruited in centres from Iran, Tunisia
and Germany. Data from the 1,141 patients who did
not receive antibiotic prophylaxis and had complete
parameters were compared with a similar number of
patients who received an antibiotic prophylaxis
matched on the basis of similar demographic
variables (i.e. gender, ASA and pre-operative stent).
LUTS were measured by a modified version of the
International Prostate Symptom Score (m-IPSS).
The strength of association between severe LUTS and
socio-demographic, lifestyle and health-related factors
was estimated, using logistic regression to calculate
odds ratios, adjusted for a range of confounding factors.
Several controversial results have been reported:
patients receiving antibiotic prophylaxis were more
likely to suffer from diabetes and to be under
anticoagulant therapy; they have a significant lower
stone burden, higher rates for complications
(bleeding and perforation) and a lower stone-free
rate; finally, they have a higher proportion of stone
impaction and readmission rate within three months.
…LUTS was associated with a
number of factors, including
modifiable risk factors, suggesting
potential targets for prevention
More interestingly, the prevalence of fever or UTI after
a URS was low overall (< 2.2%), without difference
between the two groups. On a multivariate analysis,
pooling all the cases together, risk factors to develop
a postoperative UTI were female gender, Crohn’s or
cardiovascular disease and patient with ASA III or IV.
Overall, 18.3% reported moderate, and 3.6% severe,
LUTS. Severe LUTS were more common among men
reporting previous prostate cancer (7.6%), total
prostatectomy (4.9%) or having part of the prostate
removed (8.2%). After excluding men with prostate
cancer or prostate surgery, the prevalence of
moderate-severe LUTS in the cohort (n = 95,089)
ranged from 10.6% to 35.4% for ages 45-49 to ≥ 80;
the age-related increase was steeper for storage than
voiding symptoms.
The authors reported as main findings that
administration of antibiotic prophylaxis differed from
13% to 100%; however, it is not clear if these
proportions reflect the clinical protocols applied
throughout the relevant countries other than from the
centres which participated in the study.
They also emphasised that female and patients with
high ASA were more likely to develop postoperative
fever or UTI and this is a finding easily to understand.
They finally highlighted that the prevalence of post-op
UTI/fever is not affected by the antibiotic prophylaxis.
The adjusted odds of severe LUTS decreased with
increasing education (tertiary qualification versus no
school certificate, odds ratio (OR = 0.78 (0.68-0.89)))
and increasing physical activity (high versus low, OR = 0.83 (0.76-0.91)). Odds were elevated among current
smokers versus never-smokers (OR = 1.64 (1.43-1.88)),
obese versus healthy-weight men (OR = 1.27
(1.14-1.41)) and for comorbid conditions (e.g., heart
disease versus no heart disease, OR = 1.36 (1.24-1.49)),
and particularly for severe versus no physical
functional limitation (OR = 5.17 (4.51-5.93)).
It is also interesting to note that the authors cited the
EAU guidelines in recommending the use of antibiotic
prophylaxis only for those patients treated by URS for
proximal or impacted stones. This recommendation is
reported in the EAU Guidelines for Urological
Infections, which is not entirely consistent with what
is recommended in the EAU Guidelines for
Urolithiasis, where it is stated that a short-term
antibiotic prophylaxis should be administered prior to
a URS anyway (LE 4; GR A).
The authors concluded that LUTS was associated with
a number of factors, including modifiable risk factors,
suggesting potential targets for prevention.
The authors also correctly reported results from two
randomised controlled trials where the results tended
to support the use of antibiotic prophylaxis.
TRIAL REGISTRATION: clinicaltrials.gov Identifier:
NCT00931528.
Unfortunately, no recommendation can be given on
the basis of the findings of this paper because of the
study limitations. More extensive and robust data are
needed to eventually identify patients who cannot
necessarily receive an antibiotic prophylaxis prior to a
URS for ureteric stones.
Source: Relationship between lifestyle and
health factors and severe Lower Urinary Tract
Symptoms (LUTS) in 106,435 middle-aged and
older Australian men: Population-based study.
Smith DP, Weber MF, Soga K, Korda RJ, Tikellis
G, Patel MI, Clements MS, Dwyer T, Latz IK,
Banks E.
PLoS One. 2014 Oct 15;9(10):e109278. doi: 10.1371
Antibiotic prophylaxis prior
ureteroscopy for ureteric
stones: Myth or need?
The Clinical Research Office of the Endourological
Society (CROES) is a well-known large international
database with different branches investigating the
clinical and surgical practice for the treatment of
urolithiasis worldwide.
One of the latest publications of CROES was focused
on the role of the antibiotic prophylaxis in preventing
the onset of urinary infection after ureteroscopic stone
removal, in patients with negative baseline urine
Key articles
16
Source: Postoperative infection rates in patients
with a negative baseline urine culture
undergoing ureteroscopic stone removal:
a matched case-control analysis on antibiotic
prophylaxis from the CROES URS Global Study.
Martov A, Gravas S, Etemadian M, Unsal A,
Barusso G, D'Addessi A, Krambeck A, de la
Rosette J.
J Endourol. 2014 Sep 5. [Epub ahead of print]
The lower pole stones:
A historical dilemma to an
end?
The dilemma on how to treat the lower pole stones
has excited endourologists in the last 10 to 20 years.
In the mid ‘90s, Lingeman et al showed that the
Shock Wave Lithotripsy (SWL) poorly performed in this
setting of stone patients.
In the early 2000s, flexible ureteroscopy (fURS) was
supposed to combine the high stone-free rates
obtained by a percutaneous lithotripsy (PCNL) and the
low complication rates of SWL; unfortunately, Pearle
et al in a randomised controlled trial showed no
significant difference between the SWL and fURS in
terms of stone-free rates (SFR) and a higher
complication rates for fURS. However, this study was
focused on lower pole stones < 1 cm.
On the other hand, several papers have been
published in the last years supporting the use of
fURS, mainly in the case of lower pole stones > 1 cm,
even though in most of the cases the quality of the
studies was suboptimal.
The latest and more robust evidence comes from an
Indian group which compared safety and efficacy,
SWL and fURS in a prospective randomised
comparison for lower pole stones ≤ 2 cm. Patients
were randomised by using a computer randomisation
table. A total of 90 +90 patients were included in the
final analysis.
Stone-free rates were comparable in both groups;
surprisingly, SWL performed much better in this study
than how it was historically described, with a SFR at a
three-month follow-up of 84.9% for lower pole
stones < 1 cm and 78.4% for lower pole stones of 1-2
cm, with respect to the < 50% in average reported in
literature.
Complications rates were also comparable;
conversely, as expected, SWL accounted for a higher
retreatment rate, but no difference was found in
terms of auxiliary procedures needed (fURS or PCNL
for SWL group; PCNL for fURS group).
The conclusion of the authors is
in line with previous evidences
and the recommendation from the
guidelines: for lower pole stones <
1 cm, SWL is safer, less invasive and
with comparable efficacy to fURS
Mr. Philip Cornford
Section editor
Liverpool (GB)
[email protected]
rlbuht.nhs.uk
Fifty and 53 patients were included in the HoLEP and
PVEP groups, respectively. Operating time, hospital
stay and time to catheter removal were comparable
between both groups. There was significant,
comparable improvement of IPSS and PVR at 1, 4 and
12 months. After four months, prostate size reduction
was significantly higher in the HoLEP group (74.3%
vs. 43.1%, p = 0.001). At 12-months, Qmax was
significantly higher in the HoLEP group (26.4 ±11.5 vs.
18.4 ±7.5 mL/sec, p = 0.03). Re-intervention was
needed in two and three cases in HoLEP and PVEP
groups, respectively (p = 1.0). The mean estimated
cost per HoLEP procedure was significantly lower than
per PVEP procedure.
The investigators stated, that
compared to HoLEP, Greenlight laser
PVEP-XPS is safe, non-inferior and
effective in treatment of BPH
The investigators stated, that compared to HoLEP,
Greenlight laser PVEP-XPS is safe, non-inferior and
effective in treatment of BPH.
Trial Registration: ClinicalTrials.gov ID: NCT01494337.
Source: Green light laser (XPS) photoselective
vapo-enucleation of the prostate versus
Holmium laser enucleation of the prostate for
treatment of symptomatic benign prostate
hyperplasia: A randomized controlled study.
Elshal AM, Elkoushy MA, El-Nahas AR, Shoma
AM, Nabeeh A, Carrier S, Elhilali MM.
J Urol. 2014 Sep 24. pii: S0022-5347(14)04551-0. doi:
10.1016/j.juro.2014.09.097.
The only advantage for fURS was showed when
comparing the Efficiency Quotient (EQ) - which is the
rate between the patients rendered stone-free by the
primary intervention and those who became stone-free
SUSPEND: The trial on Medical
after an auxiliary procedure – in the subgroups of
Expulsive Therapy for ureteric
patient with lower pole stone of 1 to 2 cm.
The conclusion of the authors is in line with previous
evidences and the recommendation from the
guidelines: for lower pole stones < 1 cm, SWL is safer,
less invasive and with comparable efficacy to fURS.
For lower pole stones 1 to 2 cm, fURS is more effective
with a lower retreatment rate then SWL.
Source: A prospective randomized comparison
between shock wave lithotripsy and flexible
ureterorenoscopy for lower calyceal stones
≤ 2 cm: A single center experience. Kumar A,
Vasudeva P, Nanda B, Kumar N, Das MK, Jha SK.
J Endourol. 2014 Sep 9. [Epub ahead of print]
Green light laser (XPS)
photoselective vapoenucleation of the prostate
versus Holmium laser
enucleation in treating BPH
After the advent of the XPS (180W) 532nm-laser,
Photoselective Vapo-Enucleation of the Prostate (PVEP)
could compete with Holmium Laser Enucleation of the
prostate (HoLEP) as a size independent procedure.
The authors assessed whether PVEP-XPS is not less
effective than HoLEP for improvement of lower
urinary tract symptoms secondary to benign prostatic
hyperplasia (BPH).
A randomized controlled non-inferiority trial
comparing HoLEP to PVEP- XPS 180W was conducted.
International prostate symptoms score (IPSS), flow
rate (Qmax), residual urine (PVR), prostate specific
antigen (PSA) and prostate volume changes as well as
perioperative and late adverse events were compared.
Non-inferiority of IPSS at one year was evaluated
using one-sided test at 5% level of significance.
The statistical significance of other comparators was
assessed at (two-sided) 5% level.
stones we were waiting for?
SUSPEND is a large UK-based, double blinded,
placebo-controlled randomised trial which has been
designed to confirm/reject the hypothesis that the
Medical Expulsive Therapy (MET) with Tamsulosin 4
mg or Nifedipine 30 mg significantly increases the
spontaneous passage of ureteric stones ≤ 10 mm.
Even though several trials and systematic reviews
have showed a quicker expulsion of ureteric stones
and an improved pain relief significantly provided by
MET, there are still consistent concerns on the real
effectiveness of the treatment because of several and
diverse limitations of the above mentioned studies:
the trials have been reported to be usually small in
size, patients mainly affected by lower ureteric stones,
significant bias variably limiting the conclusions and
frequent lack of a cost-effectiveness evaluation.
Consequently, the results of the systematic reviews
have been affected by the poor quality of the pooled
data for the meta-analysis; hence the need of a large,
multicentre, randomised clinical trial as claimed by
most of them.
This trial is expected to provide
more robust and definitive
information with respect to whether
and which MET is effective in the
management of ureteric stones
The first patient of SUSPEND was recruited in
January 2011, but the study design and the
methodology have been published only at the end
of June 2014. The trial involves two intervention
arms (Tamsulosin 4 mg or Nifedipine 30mg, for 28
days) versus placebo, and randomisation is based
on 1:1:1 proportion.
Primary outcomes are 1) spontaneous passage of
ureteric stones at four weeks and 2) reduction in
EAU EU-ACME Office
European Urology Today
October/December 2014
incremental cost per quality-adjusted life years.
With respect to the latter, interestingly the trial will
not evaluate just the costs based on the National
Health reported data: as the study has been
designed to be societal, total costs will include
expenses sustained also by the participants (travel,
time, medications).
It is noteworthy that clinical outcome is defined as no
“further intervention required” which encompass
subjective clinical conditions (symptoms and stone
passage reported by the patient) and healthcare
delivery; no imaging studies have been included to
objectively report the stone status at the follow-up
appointments (at 4 and 12 week).
Based on previous data, the null hypothesis will be
rejected if the increased stone passage rate will be at
least > 25% in the MET arms compared to placebo
(> 75% vs. 50%, respectively); moreover, the authors
will investigate a supposed increase of 10% of stone
passage in the treatments arms from 75% (Nifedipine
group) to 85% (Tamsulosin group).
To test these hypotheses, the sample size has been
calculated to be 400 patients per arm at a 90% of
power and 5% of error.
This trial is expected to provide more robust and
definitive information with respect to whether and
which MET is effective in the management of ureteric
stones; this is an important goal considering that the
use of the MET is largely diffused worldwide from
many years, even though the prescription of these
drugs is still off-label.
Source: Use of drug therapy in the management
of symptomatic ureteric stones in hospitalized
adults (SUSPEND), a multicentre, placebocontrolled, randomized trial of a calciumchannel blocker (nifedipine) and an α-blocker
(tamsulosin): study protocol for a randomized
controlled trial. McClinton S, Starr K, Thomas R,
McLennan G, McPherson G, McDonald A, Lam T,
N'Dow J, Kilonzo M, Pickard R, Anson K, Burr J;
SUSPEND Study Group.
Trials. 2014 Jun 20;15:238. doi: 10.1186/1745-6215-15-238.
Higher hospitalisation rates
and infections following
prostate biopsy
The authors conducted a population-based study of
75,190 men who underwent a transrectal ultrasound
guided biopsy in Ontario, Canada, between 1996 and
2005. Hospital and cancer registry administrative
databases were used to estimate the rates of hospital
admission and mortality due to urological
complications associated with the procedure.
Of the 75,190 men who underwent transrectal
ultrasound biopsy 33,508 (44.6%) were diagnosed
with prostate cancer and 41,682 (55.4%) did not have
prostate cancer. The hospital admission rate for
urological complications within 30 days of the
procedure for men without cancer was 1.9%
(781/41,482). The 30-day hospital admission rate
increased from 1.0% in 1996 to 4.1% in 2005 (p for
trend = 0.0001).
...the hospital admission rates for
complications following transrectal
ultrasound guided prostate biopsy
have increased dramatically during
the last 10 years…
The majority of hospital admissions (72%) were for
infection related reasons. The probability of being
admitted to hospital within 30 days of having the
procedure increased four-fold between 1996 and 2005
(OR 3.7, 95% CI2.0 –7.0, p = 0.0001). The overall
30-day mortality rate was 0.09% but did not change
during the study period.
The authors concluded that the hospital admission
rates for complications following transrectal
ultrasound guided prostate biopsy have increased
dramatically during the last 10 years primarily due to
an increasing rate of infection related complications.
to biopsy, the background incidence of urinary tract
infection was approximately 2%.
Within 30 days after biopsy, 6% had a dispensed
prescription for urinary tract antibiotics and 1% were
hospitalised with an infection. The strongest risk
factors for an antibiotic prescription were prior
infection (OR 1.59, 95% CI,1.45−1.73), high Charlson
comorbidity index (OR 1.25, 95% CI 1.11−1.41) and
diabetes (OR 1.32, 95% CI 1.17−1.49).
Risk of an antibiotic prescription after biopsy
decreased from 2006 to 2011 (OR 0.79, 95% CI
0.70-0.90), whereas risk of hospital admission
increased (OR 2.14, 95% CI 1.58-2.94). No significant
increase in 90-day mortality was observed. The
absolute 90-day mortality rates for patients with
dispensed prescriptions and those hospitalised were
1% and 1.5% respectively compared to a 90-day
mortality rate of 1% for patients without infection
diagnosis.
...severe infections with hospitalisation after prostate biopsy are
increasing in Sweden and the risk
of post-biopsy infection is highest
among men with a history of UTI…
In total, 516 (1%) patients died within 90 days of
biopsy and 34 (6.6%) of these were registered as
having died due to a urinary tract infection or sepsis.
Of the patients hospitalised for infection the odds of
dying of infection related cause was high (OR 12.6,
95%CI, 2.4-61.8)) compared to if they were not
admitted, but the absolute numbers were low.
Source: Increasing Hospital Admission Rates for
Urological Complications After Transrectal
Ultrasound Guided Prostate Biopsy. Robert K.
Nam, Refik Saskin, Yuna Lee, Ying Liu, Calvin
Law, Laurence H. Klotz, D. Andrew Loblaw John
Trachtenberg, Aleksandra Stanimirovic, Andrew
E. Simor, Arun Seth, David R. Urbach and Steven The authors concluded that severe infections with
A. Narod.
hospitalisation after prostate biopsy are increasing in
J Urol 2013;189: S12-S18. DOI: http://dx.doi.org/10.1016/j.
juro.2012.11.015
Sweden. The risk of post-biopsy infection is highest
among men with a history of UTI and those with
significant co-morbidities.
Population-based study of
infections after transrectal
ultrasound guided prostate
biopsy
Source: Nationwide population-based study of
infections after transrectal ultrasound guided
prostate biopsy. Lundström KJ, Drevin L,
Carlsson S, Garmo H, Loeb S, Stattin P, BillAxelson A.
The authors estimated incidence and risk factors for
infection after prostate biopsy as well as 90-day
mortality using a nationwide Swedish sample. A
population-based study was performed on data
assembled between 2006 and 2011 of 51,321 men from
the Prostate Cancer data Base (PCBaSe) Sweden.
The primary outcome measures were dispensed
prescriptions of antibiotics for urinary tract infection
(UTI) and hospitalisations with a discharge diagnosis
of a urinary tract infection. During the 6 months prior
The Journal of Urology® (2014), doi: 10.1016/j.
juro.2014.04.098.
Freehand ultrasound-guided
transperineal prostate biopsy
In this video, the authors demonstrated a technique
that avoids the infectious risks associated with
passing the biopsy needle through the rectal wall
using a transperineal freehand technique under
ultrasound monitoring.
Patients requiring prostate biopsy were offered the
option of sedation and/or local anaesthesia.
Intravenous access was obtained for a weight-based
dose of cefazolin and propofol-induced procedural
anaesthesia. No bowel preparation, prior rectal swab,
or pre-/postoperative antibiotics were used. Patients
were draped in a dorsal lithotomy position, using
tape to secure the penis and testicles. A povidone–
iodine swab, 10%, was used to prepare the
perineum. Transrectal ultrasound of the prostate was
performed for measurement and identification of
potentially pathological regions.
None of the patients suffered any
postoperative physician or hospital
intervention nor experienced any
complication ≥ Clavien Grade I
A 14-gauge needle was placed into the perineum at
the midprostate on each side. Approximately 10 mL of
2% lidocaine was infiltrated into the skin,
subcutaneous tissue, and pelvic floor. Under
ultrasound supervision, the Bard 18-gauge biopsy
gun (Bard Max-Core22 mm; Bard Medical) was
placed and reintroduced through the 14-gauge
needle into the prostate, with ultrasound-confirmed
tip location.
Three separate regions of the prostate (far lateral,
middle, and apical) were sampled. Based on the size
of the prostate gland, two to four tissue samples were
obtained from each region. Pressure was applied to
the perineum and a small amount of bacitracin was
applied to the puncture sites. Patients were discharged
following recovery from propofol anaesthesia and
were instructed to avoid lifting for 24 hours.
Two hundred and thirteen patients underwent
freehand transperineal prostate biopsy from January
2012 to October 2013. All patients opted for sedation.
Biopsy was performed within 10 minutes, and total
room time within 15 minutes. None of the patients
suffered any postoperative physician or hospital
intervention nor experienced any complication
≥ Clavien Grade I. All episodes of haematuria were
self-limiting.
The technique described uses the same equipment as
the traditional transrectal technique except for a
14-gauge needle and may feasibly be performed
under local anaesthesia within the time frame usually
allotted for a transrectal technique with an incidence
of infection and hospitalisation of zero.
Source: Freehand Ultrasound-Guided
Transperineal Prostate Biopsy: Technique and
Early Results. DiBianco JM, Allaway M.
Jounal of Endourology, January 2014. doi: 10.1089/
vid.2014.0046
Key articles
Aldo Vittorio Bono
Dedicated doctor and true friend
1934 - 2014
Family and colleagues mourn the passing of Aldo
Vittorio Bono who died in Varese, Italy on 25
August 1914.
involving pathologists and basic scientists. Aldo
authored (or co-authored) more than 300
scientific publications. But aside from his scientific
pursuits he also had a very deep interest in art
and music. He played the guitar and took courses
in painting.
Aldo graduated at the Milan University in 1959
with specialisation in urology, general surgery and
paediatric urology. He became a professor of
surgical pathology in 1971 and three years later
was appointed chairman of the Department of
Urology in Varese where he remained until he
retired in 2006. He was also teaching professor of
uro-oncology at the University of Pavia and
Brescia.
Despite his illness in 2006 he never allowed it to
dampen his enthusiasm for his work, and even
made plans for and joined voluntary service. In
2008 Aldo was nominated vice-president of
Alzheimer Association of Varese and became
president in 2012 until 2014.
In 1979 he organised the “Varese International
Meeting of Pediatric Urology” which mainly
featured live surgery, at that time considered a
unique event which gathered some of the most
renowned European and American specialists.
Aldo had a brilliant mind and was a very good
organiser. He became a member of the
EORTC-GU Group in the 1980s and was later
appointed as chairman. From 2005 to 2008 he
was president of the Italian Society of Urology.
October/December 2014
He strongly believed in multi-disciplinary
approaches in medicine and organised a special
committee within the EORTC-GU that involved
pathologists. He also prioritised translational
research and collaborated with basic researchers,
statisticians and other specialists.
Aldo was a dedicated scientist and even when he
was close to retirement he never tired of envisioning
the future of urology and medicine. I remember that
just before his retirement he discussed with me the
future of uro-oncology strategies and its prospects,
and showed his enthusiasm for multi-centre studies
I am privileged to have had the opportunity to
know Aldo personally and professionally since my
involvement with the EORTC. We have travelled
and shared ideas and projects, and he was not
only a good teacher but also a true friend. His
friendship was a source of joy to me. We lost a
great scientist and a good friend.
Ciao Aldo, rest in peace.
-By Prof. Maurizio Brausi
European Urology Today
17
CEM2014 SYMPOSIUM REPORT
Benign Prostatic Hyperplasia (BPH)
Report on Berlin-Chemie/Menarini - sponsored satellite symposium 2014
Chair: Prof. Bob Djavan, Professor of Urology,
University of Vienna (AT)
Prostatic T-Cell Products
IL-2, -4, -5, -10, -13, -17 IFN-γ, TGF-β, FGF-2
It is always interesting and challenging to moderate a
scientific symposium on the occasion of the CEM
Congress. This year’s Berlin-Chemie/Menarini
sponsored scientific event dealt extensively and
appropriately with the role of phytotherapy and more
in particular Serenoa repens extract for the treatment
of voiding difficulties associated with benign
prostatic hyperplasia (BPH).
The scientific session which took place at the Holiday
Inn Hotel in Cracow on Saturday, 11 October 2014, was
attended by approximately 150 urologists mostly
coming from Central and Eastern Europe. In these
regions phytotherapy is a largely accepted treatment
option for voiding difficulties due to BPH. Hence the
large interest of these congress delegates in the
symposium, which aimed at presenting an overview
of current evidence focusing on the reasons for BPH,
the risks
of BPH, current treatment options for BPH
rostatic T-Cell
Products
and how aggravation of BPH may be prevented. The
5, -10, -13,speakers,
-17 IFN-γ,all
TGF-β,
FGF-2 experts in urology,
well-known
presented up-to date information on novel aspects of
Typeof0 voiding symptoms due to
Type 2treatment options
BPH,
IL -4, -5, -13 pos
IL -4, -5, -13 pos
BPH
and
preliminary
IL -2, clinical
IFN-γ pos results of
IL -2, IFN-γ neg
phytotherapeutic treatment.
Type 1
IL -2, IFN-γ pos
IL -4, -5, -13 neg
Leukocytic Growth Factors of
Non-Lymphoid Prostatic Cells
IL-1α, & β, IL-6, -8, -13, -15, GM-CSF,
TNF-α, TGF-β, FGF-2, VEGF, SCF
Macrophages
& Mast Cells
IL -1, -6, -8, -13,
GM-CSF, TNF-α
Epithelial Cells
IL -1, -4, -6, -8, -13
TGF-β FGF-2, GM-CSF,
TNF-α
Stromal Cells
IL -1, -6, -8, -13
TGF-β FGF-2, GM-CSF,
TNF-α
Figure 2: Intraprostatic lymphokine network, IL = interleukin;
IFN = Interferon; TGF = Transforming growth factor; FGF =
Fibroblast growth factor; GM-CSF = Granulocyte macrophage
colony stimulating growth factor; TNF = Tumor necrosis factor;
ml/sec
VEGF = Vascular endothelial
growth factor;
maxSCF = Stem cell
20
factor (Image adapted from Steiner
GE,
Djavan B, et al. 200218)
18
Q
Prostate
enlargement
20
12
0
10
-20
8
Initial
2 yrs
4 yrs
6 yrs
8 yrs
BPH
Symptoms
Inflammation
Stromal Cells
IL -1, -6, -8, -13
TGF-β FGF-2, GM-CSF,
TNF-α
Overactive
bladder
Figure 3: Factors related to BPH
Photo: A. Horstmann
Q max
10
40
14
, & β, IL-6, -8, -13, -15, GM-CSF,
F-α, TGF-β, FGF-2, VEGF, SCF
RUV
ml
60
16
kocytic Growth Factors of
-Lymphoid Prostatic Cells
Epithelial Cells
IL -1, -4, -6, -8, -13
TGF-β FGF-2, GM-CSF,
TNF-α
Type 0
IL -4, -5, -13 pos
IL -2, IFN-γ pos
Type 2
IL -4, -5, -13 pos
IL -2, IFN-γ neg
of the product further contributes to these
uncertainties. Prof. Debruyne stated that the
underlying extraction method used to produce
Prostate
compound of
Prostamol® uno, the Serenoa repens
enlargement
Berlin Chemie/Menarini is based
on an ethanol
extraction which ensures a more stable content of
active products in its formulation. Based on a
comprehensive review of the literature it can be
concluded that Serenoa repens, already
BPH known for
centuries as a management option
of BPH symptoms
Symptoms
has anti-inflammatory, anti-proliferative, proapoptopic and anti-androgenic properties which
could result in positive
clinical effect of BPH
Inflammation
Overactive
bladder
symptoms such as nocturia, for which Serenoa
repens
extract is significantly better than placebo. Prof.
Debruyne said that it remains questionable and
scientifically undefined which distinct substance is the
most important and the most clinically valid and that
these issues eventually could be clarified by further
basic research in association with the evaluation of
possible clinical findings related with the mode of
action, such as prostate volume and prostate-specific
antigen (PSA) evolution under Serenoa repens extract
treatment. The take home message of Prof. Debruyne
was “Longer treatment – better treatment!” and that
combination therapy is a promising approach in the
treatment of BPH.
10 yrs
Initial
2 yrs
4 yrs
6 yrs
8 yrs
10 yrs
How can further aggravation of BPH be prevented
(Prof. A. Z. Vinarov, Moscow (RU))
The last presenter was Prof. Andrey Vinarov, from
Moscow (RU) who published several articles about
Serenoa repens21,22 and gave a detailed update of the
long-term Russian clinical study in which patients
with mild to moderate BPH were treated with 320 mg
of Prostamol® uno once daily for ten years2. The
results underlined the long-term benefits of Serenoa
repens, namely, the reduction in IPSS score and the
improved QoL2. In addition, the treatment displayed
the high tolerability of Serenoa repens extract with no
serious adverse events2 and confirmed earlier results3.
This aspect may be the main advantage of treatment
when compared to other pharmacological treatment.
Treatment options of BPH symptoms
(Prof. F. M. J. Debruyne, Arnhem (NL))
After the first introduction into the multifactorial
reasons and the risk factors of BPH, Prof. Debruyne
from Arnhem (NL) summarized current treatment
options. He highlighted that the main aim of therapy
has to be the improvement of bothering symptoms
and quality of life (QoL) and the prevention of
BPH-related complications such as urinary retention
9
.
or upper
urinary
tract
dilatation
Initial
2 yrs
4 yrs
6 yrs
8 yrs
10 yrs
RUV
Prof. Bob Djavan
Symposium Chair
References
1. IuG Aliaev, et al., "[Efficacy and safety of prostamol-UNO in
the treatment of patients with initial symptoms of prostatic
adenoma and risk of progression: 2 years of
investigations]," Urologiia (4), 36 (2009).
2. IuG Aliaev, et al., "[The results of the 10-year study of
efficacy and safety of Serenoa repens extract in patients at
risk of progression of benign prostatic hyperplasia],"
Urologiia (4), 32 (2013).
3. A. L. Avins, et al., "Safety and toxicity of saw palmetto in
the CAMUS trial," J Urol. 189(4), 1415 (2013).
4. Y. Bostanci, B. Djavan et al., "Correlation between benign
prostatic hyperplasia and inflammation," Curr. Opin. Urol.
23(1), 5 (2013).
5. J. Breza, et al., "Prostamol uno (alcohol extract of the fruits
of Serenoa repens) in the treatment of symptomatic benign
prostatic hyperplasia," 54(4), 139 (2005).
6. F. Debruyne, et al., "[Evaluation of the clinical benefit of
Permixon and tamsulosin in severe BPH patients--PERMAL
study subset analysis]," Prog. Urol. 14(3), 326 (2004).
7. F. Debruyne, et al., "Comparison of a phytotherapeutic
agent (Permixon) with an alpha-blocker (Tamsulosin) in
the treatment of benign prostatic hyperplasia: a 1-year
randomized international study," Eur Urol. 41(5), 497
(2002).
8. S. Fujikawa, et al., "Natural history of human prostate
gland: Morphometric and histopathological analysis of
Japanese men," Prostate 65(4), 355 (2005).
9. S Gravas, et al., 2014. S Gravas, et al., “Extended
Guidelines 2014 Edition, Guidelines on the Management of
Non-Neurogenic Male Lower Urinary Tract Symptoms
(LUTS), incl. Benign Prostatic Obstruction (BPO)” 2014.
10. M. M. Issa, et al., "An assessment of the diagnosed
prevalence of diseases in men 50 years of age or older,"
Am J Manag. Care 12(4 Suppl), S83-S89 (2006).
11. S. J. Jacobsen, et al., "Treatment for benign prostatic
hyperplasia among community dwelling men: the Olmsted
County study of urinary symptoms and health status," J
Urol. 162(4), 1301 (1999).
12. G. Kramer and M. Marberger, "Could inflammation be a
key component in the progression of benign prostatic
hyperplasia?," Curr. Opin. Urol. 16(1), 25 (2006).
13. G. Kramer, D. Mitteregger, and M. Marberger, "Is benign
prostatic hyperplasia (BPH) an immune inflammatory
disease?," Eur Urol. 51(5), 1202 (2007).
14. J. C. Nickel, "Inflammation and benign prostatic
hyperplasia," Urol. Clin North Am 35(1), 109 (2008).
15. R. Rosen, et al., "Lower urinary tract symptoms and male
sexual dysfunction: the multinational survey of the aging
male (MSAM-7)," Eur Urol. 44(6), 637 (2003).
16. A. Sciarra, et al., "Prostate growth and inflammation," J
Steroid Biochem. Mol. Biol. 108(3-5), 254 (2008).
17. I. Sinescu, et al., "Long-Term Efficacy of Serenoa repens
Treatment in Patients with Mild and Moderate
Symptomatic Benign Prostatic Hyperplasia," 86(3), 284
(2011).
18. G. E. Steiner, B. Djavan et al., "The picture of the prostatic
Prostate
lymphokine network is becoming increasingly complex,"
enlargement
Rev. Urol. 4(4), 171 (2002).
19. G. E. Steiner, et al., "Expression and function of
pro-inflammatory interleukin IL-17 and IL-17 receptor in
normal, benign hyperplastic, and malignant prostate,"
Prostate 56(3), 171 (2003).
20.G. E. Steiner, et al., "Cytokine expression
BPHpattern in benign
prostatic hyperplasia infiltrating T cells and impact of
Symptoms
lymphocytic infiltration on cytokine mRNA profile in
prostatic tissue," Lab Invest 83(8), 1131 (2003).
21. A. Z. Vinarov, et al., "[Results of three-year clinical study of
prostamol uno efficacy and safety in patients with initial
Inflammation
Overactive
symptoms of prostatic adenoma and risk of its
bladder
progression]," Urologiia (6), 3 (2010).
22. A. Z. Vinarov, IuG Aliaev, and K. L. Lokshin, "[Safety of
continuous (more than 1 year) intake of Serenoa repens
extract by patients with prostatic adenoma]," Urologiia (1),
84, 86, 87 (2009).
Furthermore, Prof. Vinarov displayed that the
treatment with Serenoa repens decelerated further
prostate enlargement and that the prostate volume
10
18
was slightly reduced when compared to the control
60
16
group after ten years2. These results suggest that this
40
14
Figure 1: The speakers of the BPH Symposium at CEM 2014,
treatment and the assumed anti-inflammatory
20
12
Cracow in order of the presentations: Prof. Djavan (AT), Prof.
properties of Serenoa repens extract may contribute to
0
10
Debruyne (NL) and Prof. Vinarov
the prevention of the further prostate enlargement.
-20
8
After the presentation of Prof. Vinarov, Prof. Breza sr,
Initial
2 yrs
4 yrs
6 yrs
8 yrs
10 yrs
also a well-known expert on phytotherapy from
What are the reasons for BPH, its progression and
At the moment, several pharmacological treatment
Bratislava (Slovakia) and the author of a Slovakian
risks for the patient? (Prof. B. Djavan, Vienna (AT))
options (monotherapy or combination therapy),
study which included more than 600 patients, who
surgical, minimal invasive therapy and watchful
had a follow up of 12 months, explained that the
The opening of the session underlined the extent to
T-Cell Products
anti-inflammatory
properties of Serenoa repens
which the management of voiding symptoms due to
waiting are available for urologists. Mainly used Prostatic
extract
are
mainly
due
toFGF-2
inhibition of the
BPH impacts the day-to-day work of urologists, since pharmacological therapies include the prescription
of
IL-2, -4, -5, -10, -13, -17 IFN-γ, TGF-β,
inflammatory enzymes cyclo-oxygenase and
this condition is the fourth most important health care α1-blockers (e.g. Tamsulosin) or 5-α-reductase
issue of men ≥50 years in the US physicians are faced inhibitors (e.g. Finasteride) or a combination of both
lipo-oxygenase5.
Type 0
Type 2
Type
1 no
with10. These symptoms have a major influence on
in men with moderate symptoms (IPSS 8-19)
with
IL -4, -5, -13 pos
IL -4, -5, -13 pos
IL -2, IFN-γ pos
15
IL
-2,
pos
IL -2,end
IFN-γofneg
erectile function and will aggravate when not
indication for surgery. But since these IL -4, -5, -13 neg
At the
this interestingIFN-γ
symposium
all speakers
treated10.
pharmacological approaches do not target the
agreed that there is still a need to institute early
processes of inflammation associated with BPH, and
treatment for these conditions before they progress
10
In recent years there is a change in perception of BPH. show side effects like orthostatic hypotension, erectile
and require
more
extensive
Leukocytic
Growth
Factors
of and costly intervention
It is clear that BPH is a progressive, age-related
dysfunction, retrograde ejaculation, anejaculationNon-Lymphoid
and and that patients
suffering
from
voiding
difficulties
Prostatic Cells
gastro-intestinal problems, alternative approaches are due to BPH the treatment outcome is more important
disorder. However, new studies assume that
IL-6,the
-8,scientifically
-13, -15, GM-CSF,
inflammation seems to additionally have a serious
mandatory, since these adverse effects may be IL-1α, & β,
than
based clinical evidence. Like in
TNF-α, TGF-β, FGF-2, VEGF, SCF
4,12-14,16
impact on bothersome symptoms related to BPH
. embarrassing for the patients who mostly need
many diseases evidence based therapeutic results do
It seems that there are three major components
continuous treatment for their BPH symptoms.
not always equal the clinical (partly subjective)
Macrophages
contributing to clinically relevant voiding symptoms,
improvement
seen in non-prospectively
randomized
Epithelial Cells
Stromal Cells
& Mast Cells
IL -1,but
-4, -6,as
-8,stated
-13
IL -1,
-6, -8, -13 further research,
As presented, one of the main aspects should
be
the
namely, the prostate, inflammation and the bladder.
trials,
by
the
speakers
IL -1, -6, -8, -13,
TGF-β FGF-2, GM-CSF,
TGF-β FGF-2, GM-CSF,
GM-CSF,
TNF-α by namelyTNF-α
Several recently published studies demonstrated,
inhibition of inflammation, which may be
achieved
well designed clinical
studies are needed to
TNF-α
inflammation, evidenced as inflammatory cell
additionally applying herbal products. Several herbal identify the mode of action and the long-term impact
infiltration and up-regulation of several inflammatory products for the treatment of BPH exist, and the most of Serenoa repens extract in the treatment of voiding
prominent and most studied is the extract of Serenoa difficulties in mild to moderate BPH.
markers are often present in patients with BPH8,19,20.
repens1,2,6,7,17,21,22. As explained by Prof. Debruyne,
Main risk factors for the progression of BPH and
associated voiding difficulties are age, symptoms,
phytotherapy, although well recognized as a clinically
flowrate (Qmax), prostate volume and prostate-specific valid therapeutic option, is usually considered as
insufficiently scientifically evidence based and this is
antigen (PSA) concentration11. In addition, the loss of
elastic fibers in the bladder tissue, which is a normal one of the reasons why it is not (yet) recommended in
ml
ml/sec
max
20
part of the aging process, contributes to clinically
the EAU Guidelines for the treatment of BPH. In its
10
18
relevant symptoms in men as well as in women.
2014 edition the EAU Guidelines committee concluded
Therefore, voiding symptoms cannot be monocausally that it was not yet able to formulate specific
60
16
explained by only prostate alterations.
recommendations on phytotherapy of BPH because of
40
14
the heterogeneity of products and the methodological
20
12
The take home message for the audience was that all problems associated with meta-analyses, but Prof.
0
10
aspects contributing to bothersome symptoms have to Debruyne explained that this is mainly related to the
-20
8
be kept in mind, that inflammation may be a potential different extraction methods of the Serenoa repens
Initial
2 yrs
4 yrs
6 yrs
8 yrs
10 yrs
Initial
2 yrs
4 yrs
6 yrs
8 yrs
10 yrs
therapeutic target and that the assessment of
extract. The heterogeneity of the substances included
patient´s history is important to find the best
in the compound and the different extraction methods Figure 4: Changes in Flowrate (Qmax, left) and Residual urinary volume (RUV, right) observed with daily treatment with Serenoa
treatment option.
for Serenoa repens resulting in different compositions repens (Image adapted from Aliaev et al. 20132)
ml/sec
20
ml
Q
18
European Urology Today
RUV
October/December 2014
14th CEM: Closing the gap between East and West
Meeting demonstrates the high level of urological research in Central Europe
By Monique Van Hout
incidentalomas in elderly patients who often suffer
from comorbidities which make them unfit for surgery.
Sedelaar showed that the mortality rate in this
particular patient group is low because small masses in
the kidney tend to grow slowly and there is a very low
risk that they progress to metastatic disease.
The 14th EAU Central European Meeting (CEM) held in
Cracow, Poland from 10-12 October, was an illustration
of the high level of urological clinical care and scientific
research in the region. Prof. Bob Djavan (Vienna, AT),
Chairman of the EAU Regional Office, praised the high
number of submitted abstracts, as well as their quality, Sedelaar stressed that not all small lesions are
and proclaimed that urology in Central Europe is “at
harmless and partial nephrectomy remains the gold
Western European standards.”
standard in young and otherwise healthy patients.
Furthermore, the lack of biomarkers for kidney cancer
Djavan mentioned in his opening address that the value makes it difficult to predict whether or not a tumour is
of this meeting lies in the opportunity it provides to
aggressive.
identify key opinion leaders from Central Europe, to
offer young urologists in the region a bridge to the
Because of this, the role of renal tumour biopsy is also
Annual EAU Congress, and, most importantly, to
changing. Now that it has been established as a safe
strengthen the urological network.
and accurate diagnostic tool, biopsy can be important
in determining histology. Only for patients who are
Prof. Piotr Chlosta (Cracow, PL), Chairman of the 14th
unfit for any type of active treatment is renal biopsy
CEM, agreed with Djavan and said he is satisfied with
unnecessary. Alternatively, patients who are unfit for
the quality of the scientific programme and proud of
surgery can be treated with various ablative treatment.
the support he has gotten to organise this meeting. He These techniques are still experimental and require a
stressed that it is the satisfaction of the participants that pre-treatment biopsy.
determines the success of any meeting.
Dr. Dejan Bratus (Maribor, SL) discussed treatment
Attendees of the meeting were offered a full
options for patients with metastatic kidney cancer. Even
programme with state-of-the-art lectures on for
though more randomised data is needed, surgery is
instance prostate, kidney, and bladder cancer; as well
indicated as a palliative approach, in combination with
as hands-on training sessions, poster sessions, a
systemic therapy. Studies show that immunotherapy is
newly-introduced video session on various laparoscopic more effective after nephrectomy. Surgery can even be
techniques of partial nephrectomy, and a Young
curative if all metastases can be removed and should
Urologists Competition.
be offered to all patients who are fit enough for
surgery.
Personalised cancer treatment
As of next year, Polish law mandates that cancer
patients have to be treated by a multidisciplinary team.
This is why the lecture of the Polish Association of
Urology focused on personalised medicine in a
multidisciplinary approach. Prof. Krzysztof
Krzemieniecki (Cracow, PL) said that the simplest
definition of personalised medicine is still the best:
customised medical care for every patients’ unique
condition.
It is now clear that there are many different
characteristics for cancers originating in the same
organ. The heterogeneity of cancer is becoming more
apparent. Krzemieniecki described the history of cancer
treatment from blockbuster medicine via stratified
medicine towards personalised medicine and predicted
that the latter will become the standard approach in a
few years.
“We are all different,” Krzemieniecki said. “This is very
obvious but it is a revolutionary realisation in cancer
treatment. To take the many disease and patient
characteristics into consideration, a multidisciplinary
and holistic approach is necessary. The challenge is to
provide equal availability of such an approach,” he
continued.
Kidney cancer
Kidney cancer is an important topic for Central Europe
because of the high prevalence of the disease in the
region. This is primarily because the Czech Republic, for
reasons which are still unknown, has the highest
incidence of renal cancer in the world. Various aspects
of this heterogeneous malignancy were discussed
during a dedicated session.
Dr. Michiel Sedelaar (Nijmegen, NL) talked about the
indication for active surveillance (AS) in kidney cancer.
He explained that, while partial nephrectomy is still the
gold standard treatment, and an excellent curative
option, there are reasons to investigate the possibilities
of AS in specific patient groups.
The need for this treatment modality has increased over
the years, due to the growing numbers of low-grade
One way to reduce
overtreatment is by
offering patients active
surveillance (AS). Dr.
Tomasz Borkowski
(Warsaw, PL) clearly
explained that AS is active
treatment with curative
intent. The aim of delayed
treatment is to minimize
treatment-related toxicity.
This approach is only
recommended in low or
very low-risk cancers.
AS is particularly suitable
for patients over the age
of 65. In younger patients, From left: speaker Dr. Michiel Sedelaar, with Prof. Bob Djavan and Prof. Piotr Chlosta chairing
AS can be an option but
radical prostatectomy has
present their work to a group of judges made up of
shown the best outcomes in this patient group. Even
world-renowned urologists. Most competitors
with very low-risk prostate cancer, younger patients
benefit from surgery. The personal preference should
presented research on kidney or prostate cancer but the
awards went to those who covered non-oncological
nonetheless always be taken into account, in any
topics.
patient group.
In patients with high-risk prostate cancer, radical
prostatectomy is the best treatment option. Prof. Günter
Janetschek (Salzburg, AT) showed that surgery is better
for cancer-specific survival as well as overall survival,
compared to radiation therapy. Only for the treatment of
distant metastases is radiation better, data shows.
Dr. Béla Köves, delivering his winning presentation on Urinary Tract Infections
Prof. Oliver Hakenberg (Rostock, DE) gave an overview
of the latest developments in medical treatment of
kidney cancer with tyrosine kinase inhibitors (TKI).
A lot has been invested in research on TKI, but overall
survival is not improved by these drugs. With the
exception of soranifenib, axitinib and temsirolimus,
which show some improvement in overall survival in
patients with clear cell carcinoma, Hakenberg
demonstrated that the new drugs mainly promote
progression-free survival.
Combination treatment of TKIs is not useful, Hakenberg
continued. Additionally, it is also very expensive and
appears to have no benefit on quality of life. Hakenberg
concluded that it is necessary to acknowledge the
palliative nature of medical treatment in renal cancer
and urologists need to take the high costs of the
treatment into consideration.
Prostate cancer
Another major topic at CEM14 was prostate cancer,
because of its high prevalence and incidence.
Diagnosis, active surveillance, and radical
prostatectomy were the most notable topics. The
greatest challenges in diagnosis of prostate cancer are
to distinguish between clinically significant and
insignificant tumours, to
reduce the number of
unnecessary biopsies, and
to prevent overtreatment.
“There is a need for a
new biomarker,” said Dr.
Peter Nyirády (Budapest,
HU). This is not easy
because none of the
new biomarkers meet
all requirements. MRI
will get a more
prominent role in the
diagnosis of prostate
cancers and can even be
helpful for classification.
If radical prostatectomy is
the gold standard, what is
then the role of robotassisted radical
prostatectomy (RARP)?
Djavan closed the prostate
cancer session with a
lecture on this topic. The
latest data shows that the
advantage lies in the
short-term: patients
treated with RARP show a
quicker return to potency
and continence, compared
to open radical
prostatectomy. Because of
the favourable functional
outcomes of RARP, young
patients will benefit most
from the treatment.
High costs of the procedure are the biggest downside.
Another problem mentioned by both Djavan and
Janetschek is the pelvic lymph node dissection (PLND),
which is essential in high-risk cases. Data shows that
PLND is less often performed in patients treated with
RARP compared to open radical prostatectomy.
Dr. Dinko Hauptman (Zagreb, HR) won third prize with
his presentation on the kidney transplantation
programme in Croatia. He described the country’s
donor and transplantation programme. The latter
consists of 4 transplantation centres in which
multidisciplinary teams operate. The donor programme
is based on presumed consent and has become very
successful after Croatia joined Eurotransplant: the
number of donors has increased and waiting time
decreased.
Second prize went to Dr. Bogdan Geavlete (Bucharest,
RO) for his comparative study on treatment options for
enlarged prostates with a large volume. He compared
bipolar resection, vaporisation, and enucleation and
concluded that enucleation is most feasible in high
volume prostates, whereas vaporisation is inferior in
these high-volume cases.
Dr. Béla Köves (Budapest, HU) won first prize in the
competition for his presentation on treatment of urinary
tract infections (UTI). According to Djavan the
presentation was “a good example of a good
presentation that is not about oncology.”
Although not often thought about, UTI is common
and rates of resistance are rising globally. Köves
demonstrated that, in contrast to what is commonly
believed and practised, asymptomatic bacteriuria
(ABU) can help in the prevention of UTI. According to
Köves, non-antibiotic prevention of UTI is the future.
Nonetheless, he did advise to continue to treat ABU
in pregnant women and before surgery in the
urinary tract.
“There is no doubt that
the robot will come,
”Djavan concluded. It is
therefore important to
remember that it is a tool,
and the role and skill of
the surgeon remain
crucial. Djavan: “A fool
with a tool is still a fool.”
Young Urologists
Competition
The Young Urologists
Competition is a
recently-introduced
feature of the Regional
Meetings, designed to
give young talents the
opportunity to represent
their country and to
Dr. Ignacy Korzelik (Cracow, PL) receiving the first prize for their paper on laparoscopic
adrenalectomy
CEM14 Poster Award Winners
Karl Storz Awards for Best Clinical Study
1. C138 – I. Korzelik, et al. (Cracow, PL)
Laparoscopic adrenalectomy. 10-year experience
of a single institution
2.C50 – Z. Balory and L. Pajor (Szeged, HU)
Aesthetic reconstruction of the penis after tumor
resection
3.C131 – A. Minich et al. (Minsk, BY) Predictors of
postoperative mortality after radical cystectomy
Berlin Chemie Awards for Best Basic Research
1. C78 – A.S.C. Rascu et al. (Bucharest, RO) Genetic
studies on Romanian prostate cancer patients
confirm genetic risk variants for prostate cancer
2.C144 – R. Sobotka et al. (Prague, CZ) New
potential tumor markers for primary diagnosis
of kidney tumors
3.C33 – O. Banya et al. (Lviv, Kyiv, UA) Does cell
phone radiation have a bad effect on semen
quality?
A laparoscopic hands-on training session at the CEM2014
October/December 2014
European Urology Today
19
10th SEEM reflects region’s growing role in urology
Participants from 44 countries gather in Belgrade
By Joel Vega
With a nod to the region’s growing stature in
international urology, Regional Office Chairman Prof.
Bob Djavan (AT) acknowledged the contributions and
innovative work from South Eastern Europe during
his opening remarks at the 10th South Eastern
European Meeting (SEEM) in Belgrade, Serbia.
Around 500 participants gather in Belgrade from
October 24 to 26 this year for the annual meeting, the
third time the Serbian capital is hosting one of the
Regional Office’s frontline events. With Professors
Sava Micic (RS) as meeting chairman and Aleksandar
Vuksanovic (RS) co-chairing the event, Djavan
underscored the influence of urologists from the
region.
“In the last couple of years I am happy to see that the
SEEM has evolved to a more inclusive and dynamic
event, not only gathering more participants, but also
providing the necessary platform to both young and
veteran urologists in the region. Your work and active
contributions have made this meeting a success,”
Djavan said.
(TR) spoke on the benefits of AS particularly for
elderly patients and those with co-morbidities for
which aggressive therapies only increase lifethreatening risks.
“AS remains an option but age, disease stage and
co-morbidities are key aspects that need to be
carefully examined by doctors. Most of these SRMs
have a lower malignant potential and are defined as
predominantly solid enhancing tumours less than 4
cm in maximal diameter(cT1a),” said Huri.
New trends
First-day roundtable discussions and debates tackled
topics such as ischemia in partial nephrectomy, AS in
young men with localised PCa, diagnostic markers in
PCa, new imaging techniques and current trends and
prospects in biopsy.
Among the key messages from the lectures focused
on prostate cancer. Dr. Theodore Anagnostou (GR)
spoke on new developments in PCa biopsy, and said
that despite the emergence of new techniques such as
MR-US (ultrasound) fusion-targeted prostate biopsy,
the caution from guidelines and high equipment costs
have reigned in the wider use of these techniques.
Noting the rapid changes
in imaging techniques,
Anagnostou discussed
multi-parametric ultra
sound (US), or enhanced
US in combination with
elastography, which in
some cases unfortunately
carries a significant
number of false
negatives. “Elastography
is a promising tool with
the potential to assist
detection. However, the
results are still
inconsistent. Besides,
elastography is not
recommended for initial
biopsies in the EAU
Guidelines,” he said.
Prof. Vuksanovic, co-chairing the SEEM meeting
The two-and-a-half day meeting took up a range of
topics including uro-oncology, andrology, female
urology, stone disease and paediatric urology, to
name a few, in a scientific programme that features
debates, panel discussions, a Country Competition,
poster and video sessions and a hands-on training in
laparoscopy co-organised by the EAU Section on
Uro-Technology (ESUT). The European School of
Urology also presented a course in andrology and
incontinence with overview lectures on erectile
dysfunction, stress incontinence and male infertility.
Djavan gave the EAU Lecture on salvage lymph node
dissection in prostate cancer during the opening
session, and hammered on the message that
although a viable option, salvage LND requires careful
patient selection and the use of suitable imaging
techniques. “The rationale for salvage LND might
reside in the nodal metastasising spread of PCa which
still needs to be investigated, and the requirement for
any non-systemic salvage approach is the availability
of accurate and sensitive imaging modality for
detecting nodal recurrence,” he said.
A debate on the management of small renal masses
(SRMs) followed, and complemented by lectures on
partial nephrectomy, active surveillance (AS) and
minimal invasive treatments of SRMs. Prof. Emre Huri
Participants from 44 countries gathered in Belgrade
20
European Urology Today
Prof. Raja Khauli (LB)
discusssed new PCa
biomarkers and strategies while Prof. Axel
Heidenreich gave succint overview lectures on AS in
young PCa patients and hormone therapy for PCa.
“Active surveillance is an option but there are still a
lot of questions,” said Heindenreich as he noted that
molecular characterisation of biopsy specimens is
necessary to identify aggressive cancers.
Following the poster and video sessions, a panel
discussion focused on robotic and laparoscopic
surgery, with the panellists and audience examining
issues on robotic surgery in high-risk disease and
whether laparoscopy is losing ground to robotic
procedures.
Country Competition
A well-attended and new feature in the regional
meetings, the Country Competition took centre stage
on the second day with 10 young urologists discussing
innovative approaches and findings during 10-minute
presentations before a 12-man jury.
The contest line-up was composed of 10 presenters
from nine countries with Turkey fielding two
candidates. The challengers were: Uros Bumbasirevic
(Serbia), Denis Godaj (Albania), Ahmet Güdeloglu
(Turkey), Evangelos Fragkiadis (Greece), Osman
Hadžiosmanovic (Bosnia & Herzegovina), Ilija
Kelepurovski (Macedonia),
N. Narimanikali (Iran),
Tayfun Oktar (Turkey) and
Prodromos Philippou
(Cyprus). Topics included
testis, penis, prostate and
kidney cancers, female
urology, incontinence and
stone disease. Dr.
Bumbasirevic of Serbia
won the top prize for his
discussion on quality of
life (QoL) of testis cancer
survivors, a seldom-made
study in which he
recommended that
doctor’s close follow-up
and assessment of the
patient’s QoL issues can
make a difference in their
therapy.
V. Kojovic (middle) receives the Karl Storz First Prize for Best
Poster from Profs. Djavan (L) and Sava Micic
K. Mytilekas (middle) receives the Berlin Chemie First Prize for
Best Poster from Profs. Djavan (L) and Micic
O. Ivanovski (R) receives the first prize for Best Video from
Prof. B. Djavan
Uros Bumbasirevic (middle) receives the Country Competition
First Prize from Profs. Djavan (L) and Sava Micic
Bladder cancer was highlighted in the second day
with lectures on new imaging tools in superficial
bladder cancer and controversies in high-risk
non-muscle invasive bladder cancer (NMIBC), given
by Profs. Gunter Janetschek (AT) and Levant Turkeri
(TR), respectively.
sessions. From the accepted abstracts, 171 or more
than half were submitted by participants from Turkey.
Accepted abstracts came from at least 30 countries,
with some of the submissions coming from as far as
Taiwan, South Korea and Egypt. Researchers from the
host country and Greece also topped the list of high
submissions. Top winners for the best poster
presentations were from Serbia, Greece and
Macedonia (See list of winners).
In his take-home messages, Janetschek said PDD
remains the standard tool by far, and new tools such
as SPIES, although easily
available and with
enhanced vision, still has
missing data, with its
value still unclear.
Confocal laser
endomicroscopy, on the
other hand, remains
experimental but has
potentials in combination
with PDD/NBI/SPIES.
Turkey also topped this
year’s abstract
submission, with around
324 abstracts accepted for
presentations in 14 poster Profs. Bob Djavan (L) and Sava Micic during the first plenary session
Serbia, Greece and Macedonia win first prizes
Serbia topped the Country Competition and also
reaffirmed its dominant performance in the best
posters and video prizes which went to Serbia,
Greece and Macedonia. Mid-East countries such as
Kuwait, Iran and the United Arab Emirates also did
well, bringing home four of the runner-up prizes.
Below is the complete list of winners:
Berlin-Chemie Best Poster Awards
1st Prize: K. Mytilekas, et al., “Evaluation of two
novel urodynamic parameters in the diagnosis of
female obstructive voiding" (Thessaloniki, Greece)
Country Competition
1st Prize: Uros Bumbasirevic (Serbia)
2nd Prize:Tayfun Oktar (Turkey)
3rd Prize: Prodromos Philippou (Cyprus)
3rd Prize- Co-winner: M. Ortac, et al., “Effects of
low-energy shockwave therapy on angiogenesis
factors at the penile tissue of diabetic rat,”
(Istanbul, Turkey)
3rd Prize- Co-winner: S. Bajramovic, et al.,
“Surgery for incidental adrenal mass,” (Sarajevo,
Bosnia and Herzegovina)
Karl Storz Best Poster Awards
1st Prize: V. Kojovic, et al, “Reversal surgery in
regretful male to female transsexuals after sex
reassignment surgery," (Belgrade, Serbia)
2nd Prize: M. Al-Kandari, et al, “Loupe - assisted
varicocelectomy with testicular delivery and
proximal spermatic cord occlusion with a
tourniquet for primary infertility”
3rd Prize-Co-winner: S. Shamrayev, et al. “The
prostate tissue changes in patients with BPO after
medical treatment (Donetsk, Ukraine)
3rd Prize- Co-winner: H. Aboutaleb, “Role of the
urethral plate characters in the success of
tubularized incised plate urethroplasty” (Al Ain,
United Arab Emirates)
2nd Prize: S. Saidi, et al., “Microsatellite instability
in urinary bladder cancer,” (Skopje, Macedonia)
Best Video Awards
1st Prize: O. Ivanovski and B. Shabani,
“Reconstruction of complicated urethral stricture in
two stages with buccal mucosal graft” (Skopje,
Macedonia)
2nd Prize: O. Alhunaidi, “Filarial epididymitis
diagnosed by Filarial dance sign,” (Farwaniya,
Kuwait)
3rd Prize: K. Tavakkoli Tabassi, “Fold back
perineo-scrotal flap plus penile inversion
vaginoplasty,” (Tehran, Iran)
October/December 2014
Comprehensive ESU course on male LUTS
Hungarian Society of Urology offers ESU course in 19th Annual Congress
Dr. Károly Nagy
Jahn Ferenc Dél-pesti
Kórház
Dept. of Urology
Budapest (HU)
[email protected]
gmail.com
The European School of Urology (ESU) organised a
course on complex therapy (conservative and
surgical) of the non-neurogenic male LUTS at the 19th
Congress of the Hungarian Society of Urology, and
elicited enthusiastic response for its comprehensive
programme from both participants and congress
delegates.
Knowledge of this topic is essential to the daily practice
of urologists since Lower Urinary Tract Syndrome
(LUTS) represents one of the most common clinical
complaints in adult men. Course participants included
the registered congress attendees and Hungarian
residents in urology. The high-quality, well-structured
thematic discussions included lectures by Prof. F. Van
Der Aa (BE) and Prof. G. R. Kasyan (RU) whose
presentations examined the topic clearly and concisely.
and detrusor underactivity. In addition, many other
conditions may also contribute to LUTS,” he said.
Prof. Van Der Aa examined clinical assessment.
“The first focus is to determine the specific nature of
the LUTS of the patient (storage, voiding and postmicturition). The correct assessment helps the clinician
to diagnoses and follow-up the patients,” he said.
In his second lecture, Prof. Kasyan gave an overview
of urodynamics studies in men. “The major aims of
these studies are to explore the functional mechanism
of LUTS and to identify potential risk factors for
adverse outcomes. Most terms and disease condition
are defined by urodynamics,” he said.
In the second half of the course the medical and
surgical treatment and their complications were
highlighted. Prof. Van Der Aa spoke on conservative
and medical treatments. “To give the best treatment
to patients, it is necessary to perform a good history
and clinical assessment in order to stratify the
patients to the possible therapies. Depending on the
spectrum of complaints, the risk of progression, the
presence of complications and the potential side
effects and cost of certain treatment, patients will be
offered different possibilities,” he noted.
The first half of the course examined pathophysiology
and the investigation and evaluation of symptoms.
Kasyan discussed pathophysiology and explained how
the medical practice and patient management have
evolved in the last decade. He underscored that
urologists should treat the patient based on individual
management and not only on diagnosis.
”LUTS are not necessarily related to prostatic
pathologies. Various types of bladder dysfunctions
may also be involved in the pathogenesis of LUTS,
such as detrusor over-activity, impaired contractility
Prof. Kasyan discussed surgical and minimally
invasive therapies for male LUTS. Kasyan: “The choice
of treatment depends on the assessed findings of
patient evaluation, ability of the treatment to change
the findings, treatment preferences of the individual
patient, and the expectations to be met in terms of
speed of onset, efficacy, side effects, QoL and disease
progression. Transurethral resection of the prostate
remains a golden standard treatment of patients with
enlarged prostates.”
In the last presentation Prof. Van Der Aa discussed
complications from therapies. “Even when no
treatment for male LUTS is offered, complications can
occur. All treatment decisions can have a
complication. With a good follow-up of the patient
the vast majority of these complications can be dealt
with accordingly,” he said.
quirky cases, which led to in-depth discussions and
debates.
After each part of the course, a one-one case
discussion was presented by Dr. Á. Tordé and the
author. Both presentations described interesting and
We are grateful to the ESU for organising this quality
course which improved our knowledge and help us
offer quality management to our patients.
Prof. Kasyan thanked by Prof. Tenke
Win a free registration
to Madrid in 2015!
EU-ACME members, join the MCQ quiz published
in European Urology
ESU faculty Prof. Frank Van Der AA and Prof. George Kasyan
For details, visit:
www.eu-acme.org/europeanurology
European School of Urology
www.baltic15.org
Teaching activities 2015
BALTIC15
February
2nd EAU Baltic Meeting
1-6
7-10
Hands-on training skills programme on Laparoscopy and Endourology, Caceres (ES)
European Urology Forum 2015 – Challenge the experts, Davos (CH)
March
29-30 May 2015, Riga, Latvia
20-24
EAU meetings
and courses
are accredited
by the EBU in
compliance with
the UEMS/EACCME
regulations
ESU Courses, HOT, Education and Innovation at the time of the 30th Anniversary
EAU Congress, Madrid (ES)
May
30
ESU course at the time of the EAU Baltic Meeting, Riga (LV)
July
5-11
ESU – Weill Cornell Masterclass in General urology, Salzburg (AT)
September
3-9 13th European Urology Residents Education Programme (EUREP), Prague (CZ)
ESU Organised courses at National Urological Society meetings
December 2014
14
ESU organised course on LUTS and incontinence: Where is the truth? at the time of the
national congress of the Georgian Association of Urology, Tbilisi (GE)
June
11
19
Call for Abstracts
ESU organised course at the time of the national congress of the Slovak Urological
Association, Presov (SK)
ESU organised course on Prostate cancer at the time of the national congress of the
Ukrainian Urological Association, Kiev (UA)
October
23
Deadline 1 April 2015
ESU organised course at the time of the national congress of the Moldavian Urological
Society, Chisinau (MD)
November
European
Association
of Urology
October/December 2014
2
ESU organised course at the time of the national congress of the Scientific Society of
Urologists of Uzbekistan, Tashkent (UZ)
Contact: [email protected]
ESU courses are accredited within the
programme by the EBU with 1 credit per hour
European Urology Today
21
ESU-Weill Cornell Masterclass in historic Salzburg
Collegial atmosphere in an intensive, quality masterclass
Dr. Kees Hendricksen
NKI - Antoni van
Leeuwenhoek
Hospital
Dept. of Urology
Amsterdam (NL)
[email protected]
nki.nl
It is Sunday, July 6, 2014 and I am travelling from
Amsterdam, The Netherlands to Salzburg, Austria to
attend the 10th European School of Urology (ESU)Weill Cornell Masterclass in General Urology.
The week-long Masterclass is a collaborative
programme of the ESU and the Weill Medical College
of Cornell University which aims to provide a
high-level post-graduate medical education
programme on general urology for highly-qualified,
English-speaking physicians from Central- and Eastern
Europe, Russia, Central Asia and other countries in
transition. Under the auspices of the Open Medical
Institute (OMI) – Salzburg Medical Seminars
International (SMSI), a programme of the American
Austrian Foundation (AAF), the master class is
annually held in Schloss Arenberg in Salzburg, Austria.
This year, 156 candidates applied via the AAF, and 47
candidates applied via the ESU (which I did), of which
36 young lucky urologists were selected. The
participants originated from Albania (2), Armenia,
Belarus, Belgium, Bulgaria, Croatia (2), Czech
Republic, Estonia, Germany, Greece, Hungary, Italy,
Kosovo (2), Mexico, Republic of Moldova, the
Netherlands, Romania (2), Russian Federation (2),
Serbia, Spain (2), Switzerland, Tajikistan, United
Republic of Tanzania, Turkey (3), Ukraine (2) and
Uzbekistan (2). Due to the international heterogeneity
of the group, the programme inevitably sharpens the
English language skills of the participants as they
learn from each other’s urological practices.
On Sunday evening, W.K. Aulitzky (Vienna), AAF
medical director, warmly welcomed all participants
and faculty members, and hinted that it will be a
week of extensive scientific information, interaction,
network-building opportunities and the start of new
friendships. A toast to that!
disease: diagnosis, medical treatment and prevention
of stone disease, and ureterorenoscopy, percutaneous
surgery and laparoscopic surgery to treat stones. J.C.
At the start of the week we took a pre-seminar
Coleman (New York) discussed the management of
multiple-choice test (and at the end of the week a
localised and advanced kidney cancer. The medical
post-seminar test was also taken) to examine our
management and surgical treatment of BPH were
knowledge-gap and prompt all participants to actively covered by C.R. Chapple (Sheffield) and B. Van
contribute to the course. During the week, major
Cleynenbreugel (Leuven). State-of-the-art in urethral
topics were clustered in the morning and presented
stricture surgery was covered by C.R. Chapple. Finally,
by the American–European faculty. D.S. Scherr (New
W.K. Aulitzky lectured on mentoring in medical
York), T.W. Jarrett (Washington) and S.F. Shariat
education and metabolic syndrome in urology.
(Vienna) covered prostate cancer, and discussed topics
such as screening in prostate cancer, imaging in and
Case presentations
treatment of localised prostate cancer, and treatment
For the afternoon sessions, each participant prepared
of high risk and castrate resistant prostate cancer. J.S. a case presentation, of which the five best cases were
Sandhu (New York) covered management of urinary
selected for the online library of the OMI. These were
incontinence and impotence after radical
subdivided into the topics that were lectured in the
prostatectomy.
morning. Since the group is mixed one can imagine
that the case selection varied from astonishing to
F.M.E. Wagenlehner (Gießen) and J. Angulo (Madrid)
extraordinary, sometimes almost hilarious to deadly
took up urological infections, including antibiotic
serious, and from basic care in general urology to the
prophylaxis in urological surgery, the increase in
most exquisite treatment opportunities in highly
antibiotic resistance, acute and chronic cystitis, and
specialised urology. For example, there was a case
the diagnosis and management of venereal diseases. where a shepherd got urethral trauma after he was
T.W. Jarrett (Washington), B. van Cleynenbreugel
attacked by a buffalo, or another case of traumatic
(Leuven) and G. Janetschek (Salzburg) covered stone
partial penectomy and penile reconstruction case
ESU-Weill Cornell Masterclass
in General Urology
Excellent programme impresses Turkish urologist
Dr. Ege Can Serefoglu
Bagcilar Training &
Research Hospital
Department of
Urology
Istanbul (TR)
Drs. B. Van Cleynenbreugel and G. Janetschek
provided updates on stone diseases. Prof. Chris
Chapple gave an overview on the management of
benign prostatic hyperplasia and urethral stricture
disease. Aside from the lectures, the participants took
part in hands-on training in laparoscopy and
endourology courses sponsored by Olympus Europe.
[email protected]
hotmail.com
Educational activities were not limited to the lectures
already mentioned. Cases, which were presented by
the participants, led to intense debates and increased
our awareness regarding the urology practice in other
parts of the world, from USA, Uzbekistan, and Mexico
to Tanzania. We even discussed various topics with
the lecturers during the meals and after the sessions
in the evenings. The diverse nationalities of the
participants also provided an excellent opportunity for
cultural exchanges. FIFA World Cup matches clearly
increased our excitement during the event.
Salzburg, the inspiring city and birthplace of
Wolfgang Amadeus Mozart, hosted 36 young
academic urologists from all over the world for the
ESU-Weill Cornell Masterclass in General Urology in
July 2014.
This one-week high-level programme is designed for
young academic urologists and included state-of-theart lectures, case discussions and laparoscopic
hands-on training sessions. The participants obtained
full scholarship and enjoyed the beauties of the city
while benefiting from the scientific programme with
world renowned urology experts as faculty members.
The breathtaking masterclass venue, Schloss
Arenberg, was a recently renovated 19th century
palace within walking distance to downtown
Salzburg. Attending the lectures in such a historical
atmosphere was absolutely a pleasant experience.
The masterclass started with the welcome message
from Prof. Wolfgang Aulitzky and followed by lectures
from Drs. Douglas Scherr, Thomas Jarrett, Shahrokh
Shariat and Jaspreet Sandhu. They presented various
topics related to recent advancements in prostate
cancer treatment.
During the rest of the course, Dr. F Wagenlehner gave
a summary of infectious diseases in urology while
22
European Urology Today
after “circumcision at home by master.”
Having such a case mix, it did not matter from which
country participants were originating since there were
ample opportunities to learn from each other, with
enough room to ask questions. All participants were
very respectful, open and willing to share ideas and
opinions.
In two other afternoon sessions, the group was split
to experience hands-on laparoscopy and endourology
training on various excellent training models, coached
by B. van Cleynenbreugel and T. Kalogeropoulos.
Participants who had the afternoon off visited the
Salzburg’s beautiful historic city centre. We also
enjoyed the wonderful Schloss Arenberg, which we
had for ourselves the whole week. An evening
chamber concert of classical music was also held in
the castle’s premises.
After such a delightful week I can only recommend
young urologists to apply for this free ESU course. It
gave me a warm feeling that after an educative week,
our diverse group had become more homogenous
due to the collegial spirit and true friendships we
have formed.
www.esusalzburg15.org
ESU - Weill Cornell
Masterclass in
General urology
5-11 July 2015, Salzburg, Austria
EAU Events
are accredited
by the EBU in
compliance with
the UEMS/EACCME
regulations
The ESU-Weill Cornell Masterclass provided an
excellent overview of the latest updates and
knowledge in general urology while enabling
participants to connect with their colleagues and
develop new friendships. I strongly recommend all
young academic urologists to apply for this
exceptional programme and take advantage of a
unique opportunity.
European
Association
of Urology
October/December 2014
ESU offers comprehensive course to Armenian urologists
Participants appreciate key updates on functional urology
Dr. Ruben
Hovhannisyan
Head, International
Relations Office,
Armenian
Association of
Urology
Yerevan (AM)
[email protected]
yahoo.com
On September 26, 2014 the Armenian Association of
Urology’s 2014 Annual Meeting opened with a course
organised by the European School of Urology (ESU), a
much anticipated and well attended course that has
become a mainstay in the programme of the
Armenian national meeting.
To Armenian urologists the ESU Course is a highlight
and we always look forward to these courses since it
serve both educational and cultural aims. By cultural,
we mean professional cultural development of the
audience. Events like the ESU course have also taught
several generations of urologists to adhere to unified
standards of professional approaches. Moreover,
these courses can serve as a “bridge” between
generations, since gaps in training and knowledge
are not only addressed but also skills and expertise
are shared or disseminated among the country’s
urologists.
Holding these courses also demonstrates the aim to
maintain high quality professional standards, and
provide the necessary support to the goal of making
our specialty a stronger medical discipline. Certainly,
the ESU Courses also provide the opportunity for us to
train our younger colleagues and thus contribute to
the general objective of boosting the influence, scope
of practice and expertise of urology.
To us these are the multi-faceted goals and
accomplishments of organising the ESU courses,
making this event an ideal platform upon which
urologists in Armenia can acquire new skills. By
keeping us updated with the latest information,
procedures and research findings we can find our
place in the bigger and professional medical world.
The ESU course last September, headed by Prof.
Aulitzky, has definitely left an indelible mark in
Armenian urologists, having enriched us with new
skills and advanced knowledge. Among the course
topics are the functional aspects of urinary and sexual
(both male and female) disorders. The topics were
not only carefully selected, but the lectures also
examined core issues and salient aspects. Course
participants expressed their satisfaction over the very
interactive and enthusiastic discussions, with the
session moderators and presenters doing their best to
stimulate the audience and address their queries.
Organisers of the Armenian Association of Urology and faculty of the ESU course gathered on the opening day of the meeting
Prof. Aulitzky, Ms. Anna Maria Nics, Karina Van Lenthe (EAU)
en Dr. John Heesakkers at the 9th century Island Monastery of
Sevanavank
The session on functional urology also tackled normal
functionality, how disorders arise and various issues
in dysfunction, which is a hugely heterogeneous
topic. The organisers also achieved their aim to
present a course where the emphasis is more on the
quality of content and that the key messages, both
practical and theoretical, are clearly conveyed to and
learned by the participants. Undoubtedly, the team of
Prof. Aulitzky has done a great job.
On behalf of the Armenian Urological Association, we
are grateful to our guests and lecturers, Prof. Aulitzky,
Drs. John Heesakkers and George Kasyan.
Our special thanks to Ms. Karina van Lenthe for her
dedication and to the EAU leadership for their
support and commitment to urology in Armenia, and
to all those who participated, contributed and made
the event a big success.
Simulation fellowship: growth of a new research field
Understanding the technical aspects of surgical skills
Dr. Domenico
Veneziano
Ospedali Riuniti BMM
Dept. of Urology and
Kidney
Transplantation
Reggio Calabria (IT)
[email protected]
domenicoveneziano.it
I left my daily surgical practice in October 2013 to
start a one-year research fellowship at the
University of Minnesota, Minneapolis, USA.
Making the decision to put my surgical practice on
hold is difficult, as the fear of having your surgical
skills atrophy is high when you plan to dedicate
all your working time to something else, even for
just one year.
medical school lectures, train-the-trainer sessions,
practical skills building and simulation centre
management.
After the first few weeks I began to understand that
“training” was not just performing basic tasks or
sessions on pig/cadaver. Simulation in urology can
be considered as a whole new field of research that
finds its roots in a deep understanding of our
everyday procedures. To understand these even
better, it is often useful to perform a “cognitive task
analysis” (CTA), a procedure that facilitates the
deconstruction of the surgical procedure in steps.
Once the CTA is completed, there is a multidisciplinary collaboration, which leads to the design
and ultimately creation of one or multiple dedicated
simulators. The possibilities offered by SimPORTAL
from this point of view are endless.
The aim was to follow my passions and to focus on
something I’ve always loved: education and
simulation technologies. SimPORTAL (Simulation
PeriOperative Resource for Training And Learning)
offered me every tool I could dream of to deepen my
knowledge about surgical training. The centre is
directed by Dr. Robert Sweet, a urologist renowned
in the United States as a pioneer in training and
simulation. Thanks to his dedicated work,
SimPORTAL is today the only place in United States
where a multi-disciplinary group of uniquely
talented experts works everyday to find novel
solutions in the field of medical education.
The team includes surgeons, clinician educators,
educational psychologists and psychometricians,
electrical/mechanical/biomedical engineers, graphic
artists, make-up artists, manufacturing and sales/
marketing experts, all paired with military
collaborative research efforts and funding. The
fellowship provided is the first simulation
programme accredited by the American College of
Surgeons (ACS) and incorporates several activities:
simulator development, curriculum development,
October/December 2014
Anaplastology lab
The anaplastology lab, directed by Troy Reihsen,
attracted my curiosity from the very beginning.
Synthetic body parts, airway models, ureteral models
for endoscopy were just a part of the number of
prosthetics one could find in this dedicated
laboratory. The process to follow in order to create a
synthetic organ, has been one of the most valuable
things I have learned at the University of Minnesota,
where the starting point is always the patient. After
acquiring the anatomy with 3D imaging, the graphic
artist needs to “digitally clean” organs that are then
3D printed to create a solid model. When more detail
is needed, the make up artists add additional effects
manually with clay, starting from surgical pictures or
actual ex vivo models.
The consistency of silicones to be used, as well as
their colours, are then chosen starting from the
internal “tissue property database.” This dataset
holds different information acquired by several ex vivo
tissue samples. This process allows the synthetic
tissues to behave as close as possible to the real ones,
giving more value to the training sessions. Working
part of my time in close collaboration with the team, I
quickly learned how to sculpt clay, build a mould and
choose the right silicon, in order to create the models
I wanted to.
In this phase the help of my wife, who left her job in
Italy to follow me in this adventure, has been critical,
as she decided to volunteer at the University and
learn with me the art of creating a training model
from scratch. Her collaboration is very important
when I decide to replicate this knowledge base
elsewhere.
With Dr. Robert Sweet, director of SimPORTAL
of assessment and validation. In this field, the
presence of several engineering companies around
Minneapolis has been beneficial: to assess a practical
exercise advanced technologies are often useful. “It’s
not the tool, it’s the tissue,” Dr. Sweet often reminds
me, and this is why the use of sensors is fundamental
to assess our respect for tissues during a simulated
procedure and, finally, to assess its correct
accomplishment.
In case a physical simulation model does not fit the
specific needs of a training session, a team of
engineers inside SimPORTAL can be involved in the
creation of a virtual simulator, which previously
occurred for the AMS Greenlight simulator in 2011.
My wife Cristina modelling clay in the anaplastology lab
After almost one year of research in the vast field
of medical training, I can say that not only do I
know more about education, but I also understand
more now the technical aspects of my surgical
skills. This has left me without any doubt as to the
Another fundamental part of my simulation
path I have chosen in coming to the University of
fellowship was the improvement in my understanding Minnesota.
European Urology Today
23
• What do you think is the biggest challenge in urology?
It’s adapting to the very rapid changes in our work environment,
most of which are totally fascinating such as image-guided therapy.
The definition of a surgeon is changing very quickly and not everyone
is prepared to make the change.
• If you were not a urologist, what would you be?
My answer would change every five years. Recently, I have been
interested in permaculture which is using building materials and other
things in a sustainable way such as agriculture. I have some
experience in innovative business. But I have no regrets about urology.
• What is your most important piece of advice for doctors just starting
out today?
I don’t like to preach but I feel it is important for young people to
identify role models to learn from. It is also important to realise your
life will have many different phases and that your values may change.
• What is the most rewarding aspect of being a doctor?
The freedom to do what I wanted to do, not to work for anybody and
to interact with a lot of very smart people.
• What is your advice to other physicians on how to avoid burnout?
I always have had trouble with this concept of work-life balance,
because to me they’re the same thing. I never really thought of
burnout.
• If you could change something in the healthcare system, what would it be?
There’s a great deal of inertia in the healthcare system. The information
systems we use are grossly inadequate. The medical profession should
be more conscious of where the financial resources are coming from
and how they’re used.
• What’s the last wonderful book you have read?
I am interested in the impact of architecture on people’s lives.
Christopher Alexander wrote “A Pattern Language: Towns, Buildings,
Construction,” which is about architecture, urban design and liveability.
• What’s the last thing that surprised you?
The reaction of voters in national elections sometimes amazes me. As
a North American I don’t understand the European concern about
immigration. I live in a city where over 50% of the citizens were born
overseas.
• What’s your favourite hour in a day and why?
I have two favourite times— when I wake up early in the morning and
have my cup of coffee, and at the end of the day just reflecting or
having a quiet time.
• What do you most often wish you could say to patients, but didn’t?
TEN QUESTIONS
Interview by Joel Vega Photography by Jack Tillmanns
Specialty: Uro-oncology
City: Toronto, Canada
Recent Awards: CUA Award, Queen’s Diamond
Jubilee Medal from the Canadian Medical Association,
AUA Honorary Member & Distinguished Contribution
Award, SUO Medal
Obviously, the biggest problem is when you know somebody is going
to die and you can’t really tell them the whole story.
Michael Jewett
Masterclass in advanced 3D video-assisted urological surgery
ESUT event in Braga, Portugal draws enthusiastic trainees
Prof. Riccardo
Autorino
University Hospitals
Case Medical Center
Dept. of Urology
Cleveland (USA)
[email protected]
Prof. Estevão Lima
Hospital of Braga
Dept. of Urology
Braga (PT)
[email protected]
ecsaude.uminho.pt
As part of its goals to promote minimally invasive
surgeries, the EAU Section of Uro-Technology
(ESUT) co-organised the Masterclass in Advanced
3D-Video-Assisted Urological Surgery, a two-day
Faculty members Kris Maes and Burak Turna were tutors in the
hands-on session
EAU Section of Uro-Technology (ESUT)
24
European Urology Today
educational course held from July 11 to 12, 2014 in
Braga, Portugal.
to ask questions regarding the procedures. The
hands-on training sessions, which were a highlight of
the course, were held at the Karl Storz Training
Center, permanently hosted at the Minho University
laboratories. The laboratories are equipped with
unique cutting-edge training facilities for a variety of
hands-on courses in various surgical specialties.
Braga, one of Portugal’s biggest cities and called
during the Roman Empire as “Bracara Augusta,” is
renowned for its history and rich cultural legacy.
Braga is also home to the School of Health Sciences of
University of Minho, an internationally known
academic centre. The centre’s faculty is involved in
many initiatives and projects both in basic and clinical
research, as well as educational events for students,
residents and healthcare providers.
This year the 5th edition of the course was directed by
Prof. Estevao Lima, chairman of the Urology
Department at Braga Hospital, Riccardo Autorino
(Urology Institute, University Hospitals, Cleveland, OH,
USA) and Jens Rassweiler (chairman of the ESUT and
chairman of the Urology Department, SLK-Kliniken,
Heilbronn, Germany). The course was part of the 2014
International Postgraduate Program of the University
of Minho Surgical Sciences Research Domain,
coordinated by Prof. Jorge Correia-Pinto.
Each year well-known experts in minimally invasive
urologic surgery join the faculty. This year’s
international guests were Professors Burak Turna
(Turkey), Pilar Laguna (Netherlands), Rafael Sanchez
Salas (France), Salvatore Micali (Italy), Marco De Sio
(Italy) and Rocco Damiano (Italy). A team of national
faculty members from across Portugal have also
actively contributed to the success of the course.
Faculty members: Estevao Lima, Rocco Damiano, Maria Pilar
Laguna, Burak Turna, Salvatore Micali, Riccardo Autorino,
Marco De Sio
interactive discussions. The live surgery session was
held at the recently opened 700-bed Braga Hospital.
Three procedures were performed: a 3D laparoscopic
nephrectomy (B. Turna), a 3D Millin simple
prostatectomy (E. Lima) and a laparoscopic partial
nephrectomy (De Sio and Autorino).
The participants followed the surgeries in small
groups directly in the operating rooms, enabling them
Under expert guidance, the participants performed
laparoscopic kidney procedures in living animal
models for a total of eight hours of hands-on training
experience. The most recent tools and instruments
supplied by the two main sponsors of the course,
Karl-Storz Endoskope and Ethicon, were available for
testing during the hands-on sessions.
Once again, the Braga ESUT-sponsored course
fulfilled its promise of providing a full and
comprehensive update on the latest advances in
laparoscopic urologic surgery. We look forward to
more participants for the 2015 course, which will be
held concurrently with the national meeting of the
Portuguese Association of Urology.
The masterclass offered practical surgical exercises
with standard laparoscopic techniques as well more
recent technology and instrumentation, including
mini and 3D laparoscopy. Lectures, live surgeries and
hands-on training were also offered. The lectures
provided not only practical insights but also a rich
video content which highlighted, in a step-by-step
manner, the most commonly performed laparoscopic
procedures in urology.
In addition, tips and tricks were provided by all
faculty members with the trainees participating in
Participants and faculty members in the hall of the School of Health Sciences of University of Minho
October/December 2014
State-of-the-art urological surgery in Heidelberg
‘Semi-Live 2015’- an innovative congress format
From January 29 to 31, 2015, Heidelberg, Germany
will host an innovative congress. “Semi-Live 2015”
will gather internationally-renowned surgeons,
including prominent EAU Section of Uro-Technology
(ESUT) members, who will present videos of complex
procedures with live commentary.
Complemented by hands-on workshops, a faculty of
surgeons will present the state-of-the-art videos of
procedures in urologic oncology, reconstruction and
stones. In collaboration with ESUT, the experts will
take up anatomical landmarks, access strategies,
important steps, elegant tricks, pitfalls and
complication management, all in dynamic and
interactive discussions.
The video recordings are carefully selected and edited
so that the resulting 15 minutes of high-definition
videos, per speaker, will prompt enthusiastic response
techniques. Workshop sessions will be held on
Thursday, 29 January. Participation is limited and slots
will be offered on a ‘first-come, first-served’ basis.
The congress venue from January 30th to 31st, 2015
will be at the Communication Center of the German
Cancer Research Center (DKFZ), Im Neunheimer Feld
280, 69120 Heidelberg, Germany. All presentations
will be in English.
from the audience. Each presentation will be followed
by sufficient time for discussion. The faculty will also
be available for specific questions in the "Speaker’s
Corner," providing the participants to carefully discuss
and examine the smallest details.
Additional in-depth knowledge can be gained in the
workshops which will feature hands-on training in
the most widely used laparoscopic urological
EAU Section of Uro-Technology (ESUT)
‘Surgery is at the heart of urology,’ said Prof. Markus
Hohenfellner. ‘And urology has been one of the most
innovative surgical specialties in modern medicine for
the last 100 years.' Today, urologists manage
indications in oncology, reconstruction, kidney stones,
BPH, and andrology by open, laparoscopic, robotic,
endourological, shock wave or microscopic
procedures. This has led to a wide range of
indications and procedures that creates a big number
of treatment options.
focuses on contemporary state-of-the-art procedures,
providing urology professionals an effective
navigation tool in an ever-changing, complex surgical
landscape. Additionally, the topics of intestinal
anastomosis and intra-abdominal vascular repair
techniques will also be highlighted as important
urological tools.
ESUT Chairman Prof. Jens Rassweiler, who will
participate as speaker and moderator, said: “ESUT is
very happy to support this outstanding event and I
look forward to welcome many EAU members to
Heidelberg in January 2015.”
Congress fee is €350. The programme has been
submitted to the LÄK Baden-Württemberg and also to
the EUACCME for CME points.
For additional information and details on the
programme and online registration, visit the
event website at www.semi-live2015.com.
With these challenges, the programme of Semi-Live
4th International Course on Advanced Laparoscopic Urology
Cluj, Romania, hosts advanced laparoscopy course
[email protected]
yahoo.com
From 25 to 27 September 2014, Cluj hosted for the
fourth year in a row the International Course on
Advanced Laparoscopic Urology. In this beautiful
university city, located in the heart of Transylvania, a
group of friends and former fellows in Heilbronn
decided to share their knowledge on minimally
invasive surgeons by organising the course under the
auspices of the EAU Section of Uro-Technology
(ESUT).
The course was held concurrently with the 28th
International Applied Advanced Laparoscopy Course
of the Turkurolap Society coordinated by Professors
Yassar Ozgok and Lutfi Tunc from Ankara, Turkey. The
course in Cluj gathered together an international team
of trainers from six countries: Romania, Turkey,
Norway, Germany, France and UK, and supervised by
our honorary presidents Profs. I. Coman and Y. Ozgok.
surgical techniques presentation and 3D live surgery
performed this year by our special guests, namely:
Prof. Antonio Alcaraz (ES), Prof Evangelos Liatsikos
(GR), Prof. Lutfi Tunc (TR), and by the host, Dr Bogdan
Petrut (RO).
At the end of the course, the organizers invited the
European School of Urology (ESU) to offer an EBLUS
exam where trainees can measure objectively their
level of training in laparoscopic manoeuvers. All 30
trainees worked in groups of two with an animal
model, guided by a trainer, and were tasked to
perform two sessions (of two hours) of live animal
training (radical nephrectomy and tissue suture and/
or ureteral / bladder anastomosis).
The live surgery day presented four live operations.
The event was credited by the EAU with the EAU live
surgery event endorsement. The first operation was a
pro peritoneal laparoscopic radical prostatectomy
performed by Dr. Petrut and his team followed by
Prof. Evangelos Liatsikos who led a single port
adrenalectomy. Prof. Lutfi Tunc performed his own
technique of a 15- minute radical nephrectomy
followed by Prof. Antonio Alcaraz who demonstrated
Using the training facilities of the University of
Medicine and Pharmacy from Cluj we organised a
programme with four sections: dry lab (EBLUS
exercises), wet lab (alive animal training), theoretical
EAU Section of Uro-Technology (ESUT)
Aspect from the live surgery transmission 3D
Make fewer passes,
use fewer products,
and reduce costs.
™
a 3D kidney tumour enucleoresection. The operations
took place in the Oncological Institute from Cluj
Napoca in two operating theatres and were
transmitted live 3D into the amphitheatre with the
group of trainees.
Given that laparoscopic surgery is a team work, we
organised this year a section for scrub and intensive
care nurses, with their participation free of charge.
During the live surgery an experienced nurse provided
expert commentary in the amphitheatre regarding the
specific manoeuvers and technical tricks. During the
Special guests from right: Assoc. Prof. Ali Gozen, Prof.
Evangelos Liatsikos, Prof. Antonio Alcaraz, Assoc. Prof. Bogdan
Petrut
Apply for your
EAU membership
online!
Go to www.uroweb.org and click EAU
membership to apply online. It will only take
you a couple of minutes to submit your
application, the rest - is for you to enjoy!
www.cookmedical.com
© COOK 2012
October/December 2014
Animal training facilities
Becoming a member is now
fast and easy!
R A P I D R E L E A S E ™ U R E T E R A L A C C E S S S H E AT H
MEDICAL
We hope that we have met the educational needs of
the trainees for an intensive applied course, and
conducted in a friendly environment. We intend to
maintain the standards of this course and we invite
you to join us next autumn in Cluj Napoca!
Would you like to receive all the benefits
of EAU membership, but have no time for
tedious paperwork?
Flexor Parallel
®
dry and wet lab they also learned the maintenance
and functionality of all laparoscopic instruments and
video systems. Theoretical sessions and presentation
for intensive care nurses were also held.
www.uroweb.org
Ass. Prof. Dr. Bogdan
Petrut
Institutul Oncologic
'Prof. Dr. I. Chiricuta'
Dept. of Urology
Cluj-Napoca (RO)
URO-BEMEAADV-FLPEUT1-EN-201212
European
Association
of Urology
European Urology Today
25
Global Action Plan on Active Surveillance for low risk PCa
Movember Foundation launches integrated project on active surveillance
Sophie Bruinsma
Postdoctoral
researcher
Erasmus MC
Dept. of Urology
Rotterdam (NL)
data. One of the aims of the project is to reduce the
number of men switching to active therapy within a
year of being on Active Surveillance with the view of
greatly improving their quality of life.
[email protected]
erasmusmc.nl
In August this year, the Movember Global Action Plan
Active Surveillance project was launched. This is an
integrated project lasting 30 months and is being
implemented across 19 institutions in 14 countries
and across five Movember regions (Australasia,
Europe, UK, Canada, USA). The initiative is also open
to other eligible centres (‘candidate centres’).
Milestones of the project include a global Active
Surveillance (AS) database for clinical, biospecimen,
imaging and biomarker data (including a virtual
biobank), as well as worldwide tailor-made
guidelines on AS and a web-based platform on AS.
Systematic PSA-based screening for prostate cancer
can reduce deaths by 21% as compared to no or little
screening, according to the latest 13-year follow-up
results of the European Randomized Study of
Screening for Prostate Cancer (ERSPC)1. However,
prostate cancer screening remains controversial, since
it is associated with the significant risks of overdiagnosis and overtreatment. Many prostate cancer
tumours do not require immediate treatment because
they're small, confined and slow growing.
Prof. Chris Bangma
Dr. Monique Roobol
The initiative is coordinated by Prof. Chris Bangma
and Dr. Monique Roobol from Erasmus Medical
Centre, the Netherlands and governed by a Research
Advisory Committee. Philips Research is responsible
for the design of the database. The Movember
Foundation has united 19 institutions, hospitals and
research centres from Australia, Canada, France,
Finland, Italy, Japan, Netherlands, UK and USA. The
initiative is open for other eligible centres to join as
well (‘candidate centres’). The Active Surveillance for
low risk Prostate Cancer Project will take two and a
half years to complete and is currently in its initial
implementation phase. Philips Research is currently
working on the integration of biospecimen, imaging
About the Movember Foundation
The Movember Foundation is the leading global
organisation committed to changing the face of men’s
health. The Movember community has raised over
$580 million to date, funding over 800 programs in 21
countries. This work is saving and improving the lives
of men affected by prostate cancer, testicular cancer
and mental health problems. The Movember
Foundation challenges men to grow moustaches
during Movember (formerly known as November), to
spark conversation and raise vital funds for its men’s
health programs. Join Movember by signing up as Mo
Bro or Mo Sista at http://www.movember.com/ to
help change the face of men’s health.
About the Movember Foundation’s Global Action
Plan (GAP)
“Our vision is to have an everlasting impact on the face
of men’s health and it’s to this end that we've
established our Global Action Plan or GAP. We believe
that getting the best researchers from around the world
to work together on key challenges will accelerate
breakthroughs that will ultimately benefit men with
prostate or testicular cancer.” - Paul Villanti, Executive
Director, Programs, The Movember Foundation.
By bringing together over 350 international
researchers, the Movember Foundation’s Global
Action Plan (GAP) facilitates a new and
unprecedented level of global research collaboration,
Accordingly, a selective approach to treatment is
required, with AS suggested as an alternative strategy
to minimise overtreatment. AS focuses on the
prevention of overtreatment by selecting patients with
low-risk disease features and strictly monitoring them
over time to recognise any potential risk
reclassification that would justify deferred radical
treatment, still with curative intent2.
In recent years, the concept of AS has become a more
viable option for men with low-risk prostate cancer
who decide not to undergo active treatment right away
and the prevalence of active surveillance is growing3.
Several AS studies have been initiated worldwide that
show favourable outcomes: the prostate cancer
mortality rate is very low, treatment is avoided in the
majority of patients, and there are quality-of-life
benefits compared with initial treatment4-8.
In 2006, the Prostate Cancer Research International:
Active Surveillance (PRIAS) study was initiated at
Erasmus MC Rotterdam to counteract overtreatment
and contribute to prospective data collection (https://
www.prias-project.org/). The PRIAS study comprises
the world's largest patient cohort followed in an AS
protocol. In this worldwide initiative, about 2500
patients with very low-risk disease from 17 countries
and three continents are presently being followed in a
mutual protocol. The aim of the study is to reflect
daily practice by collecting data from affiliated centres
worldwide using an internet-based decision tool and
the PRIAS protocol2. Preliminary data from PRIAS
support AS as a feasible strategy to reduce
overtreatment2.
Although acceptance of AS as a treatment option for
prostate cancer has been increasing, robust data from
the long-term follow-up of men with favourable or
intermediate-risk prostate cancer on AS protocols is
still limited. Many uncertainties remain, including the
long-term safety of AS9, and a reliable method for
identifying tumours which are “clinically
insignificant” is still lacking. Triggers for
implementation of curative measures, such as radical
prostatectomy and radiation treatments, remain
variable and un-validated9.
Movember project
With this in mind the Movember Global Action Plan
Active Surveillance project for low risk prostate cancer
was initiated.
The Movember Foundation has utilised its global
networks and unique position as the world’s largest
non-government funder of prostate cancer research to
unite clinicians and researches from around the globe.
The Movember Foundation has invested EUR
€1,664,950 into the Active Surveillance for low-risk
Prostate Cancer Project to create the largest centralised
prostate cancer AS database to date, comprising the
majority of the world’s Active Surveillance patient
Movember Foundation
and biomarker data, into the central database.
The second phase, commencing in 2015, will involve
developing a consensus guideline on AS based on a
review of the current guidelines available around the
world. This consensus-based guideline will be
adapted based on the outcomes of the statistical
analysis of the database and tailor-made guidelines
on AS will be generated.
These analyses will include the development of
individualised dynamic risk based strategies.
Nomograms that use the clinical characteristics of
patients at diagnosis have been developed to predict
the presence of pathologically indolent tumours.
Kattan et al10 created the first nomogram in 2003
based on PSA, biopsy Gleason grade, clinical stage,
TRUS-based prostate volume, and percentage and
total length of positive cores. Steyerberg et al11
developed an updated model more suitable for a
situation in which screening is more prevalent. The
Steyerberg nomogram is part of the so-called
Rotterdam prostate cancer risk calculator website
where besides information on PC several RC’s can be
found (www.prostatecancer-riskcalculator.com). The
nomograms predicting indolent disease can be
incorporated and further developed in the analyses of
the project.
As a next step, an online platform will be created
leveraging the Movember Foundation global
collaboration portal to allow free access to the AS
guidelines and related information. Clinicians will be
able to use these guidelines to more confidently
identify men suitable for Active Surveillance and to
also decide whose prostate cancer has progressed
and will therefore require treatment. This will provide
reassurance to men that they have made the best
treatment choice for their type of disease.
not previously seen within the prostate and testicular
cancer community. GAP was launched in 2011. There
are five GAP projects focusing on the following areas:
Global Prostate Cancer Biomarker Initiative; Imaging
in Advanced Prostate Cancer; Active Surveillance for
low risk prostate cancer; Prostate Cancer Exercise
and Metabolic Health; and Testicular Cancer
Translational Research Project. The outcomes of the
Active Surveillance for low risk prostate cancer
project will be linked to the other on-going GAP
initiatives.
In summary, over the years there has been increasing
acceptance of Active Surveillance as an alternative to
radical treatment for men with low risk prostate
cancer. Unless the over-diagnosis of indolent prostate
cancer is reduced by alternative diagnostic strategies,
active surveillance will continue to play an important
role. At this stage, active surveillance "is a treatment
approach in evolution." This initiative will make a
significance contribution to this field of research by
offering standard, universally agreed-upon
guidelines.
We would like to thank Patricio Sepulveda and Mark
Buzza from the Movember Foundation for critically
reviewing the article.
References
1. Schroder FH, Hugosson J, Roobol MJ, Tammela TL, Zappa
M, Nelen V, et al. Screening and prostate cancer mortality:
results of the European Randomised Study of Screening
for Prostate Cancer (ERSPC) at 13 years of follow-up.
Lancet. 2014 doi:10.1016/S0140-6736(14)60525-0.
2. Bul M, Zhu X, Valdagni R, Pickles T, Kakehi Y, Rannikko
A, et al. Active surveillance for low-risk prostate cancer
worldwide: the PRIAS study. EUR UROL. 2013
Apr;63(4):597-603.
3. Lund L, Svolgaard N, Poulsen MH. Prostate cancer: a
review of active surveillance. Res Rep Urol. 2014;6:107-12.
4. Bul M, van den Bergh RC, Zhu X, Rannikko A, Vasarainen
H, Bangma CH, et al. Outcomes of initially expectantly
managed patients with low or intermediate risk
screen-detected localized prostate cancer. BJU Int. 2012
Dec;110(11):1672-7.
5. Welty CJ, Cowan JE, Nguyen H, Shinohara K, Perez N,
Greene KL, et al. Extended Follow-Up and Risk Factors
for Disease Reclassification from a Large Active
Surveillance Cohort for Localized Prostate Cancer. J UROL.
2014 doi:10.1016/j.juro.2014.09.094.
6. Klotz L, Zhang L, Lam A, Nam R, Mamedov A, Loblaw A.
Clinical results of long-term follow-up of a large, active
surveillance cohort with localized prostate cancer. J Clin
Oncol. 2010;28(1):126-31.
7. Tosoian JJ, Trock BJ, Landis P, Feng Z. Active surveillance
program for prostate cancer: an update of the Johns
Hopkins experience. Journal of Clinical …. 2011.
8. Hayes JH, Ollendorf DA, Pearson SD, Barry MJ, Kantoff
PW, Stewart ST, et al. Active surveillance compared with
initial treatment for men with low-risk prostate cancer: a
decision analysis. JAMA. 2010 Dec 1;304(21):2373-80.
9. Thomsen FB, Brasso K, Klotz LH, Roder MA, Berg KD,
Iversen P. Active surveillance for clinically localized
prostate cancer--a systematic review. J Surg Oncol. 2014
Jun;109(8):830-5.
10. Kattan MW, Eastham JA, Wheeler TM, Maru N, Scardino
PT, Erbersdobler A, et al. Counseling men with prostate
cancer: a nomogram for predicting the presence of
small, moderately differentiated, confined tumors. J
UROL. 2003 Nov;170(5):1792-7.
11. Steyerberg EW, Roobol MJ, Kattan MW, van der Kwast
TH, de Koning HJ, Schroder FH. Prediction of indolent
prostate cancer: validation and updating of a prognostic
nomogram. J UROL. 2007 Jan;177(1):107-12; discussion 12.
Patients
first.
At the end of the day, it’s all about
our patients. We publish practicechanging research so that clinicians
throughout our community can
improve patient care. To involve
patients in their treatment, we now
publish summaries of each paper in
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europeanurology.com
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26
European Urology Today
October/December 2014
european
urology
Book reviews
Prof. Paul Meria
Section Editor
Paris (FR)
[email protected]
sls.aphp.fr
Cancer and Inflammation
Mechanisms
Publisher
Publication
Edition
Binding
Price
Pages
Website
: Wiley
: Aug. 2014
: 1st
: Hardcover
: 108.60€
: 400
: www.wiley.com
Urinary and Fecal
Incontinence: A training
program for children and
adolescents
Inflammation remains a physiological response from
the human body to various phenomena and
environmental factors. Inflammation is also
considered as responsible for almost 25% of cancers
since epidemiological and experimental studies have
demonstrated such correlation.
Urinary and fecal incontinence are common in
children and their incidence decreases as the age
increases. Nevertheless, children and adolescents can
be afflicted with various conditions such as enuresis,
daytime urinary or fecal incontinence and in a few
cases such problems can continue in adulthood.
These problems are stressful and can be responsible
Editors Y. Hiraku, S. Kawanishi, and H. Ohshima wrote for quality of life impairment. In many cases standard
this book as an update on the correlation between
treatments can be applied successfully but complex
chronic inflammation and cancer development. More cases require special management.
than 60 worldwide experts contributed to review
various mechanisms involved in carcinogenesis
related to inflammation and their possible prevention.
The first section of the book was dedicated to an
overview of inflammation-related cancer. The authors
focused on various aspects of inflammation and
cancer development mechanisms. They addressed the
role of stem cells and that of epithelial-mesenchymal
transition (EMT), which seems particularly involved in
tumour cell dissemination.
In this manual, editors M. Equit, H. Sambach, J.
Niemczinski and A. von Gontard, worldwide experts
in paediatric incontinence, present a training
programme intended for children and adolescents
suffering from elimination disorders.
The first part of the textbook focused on three clinical
problems: nocturnal enuresis, daytime urinary
incontinence and fecal incontinence. For each
condition, the authors considered all aspects of
classifications, various subtypes, prevalence, comorbid
disorders, psychological problems and etiology. The
assessment and treatment were addressed in the
succeeding chapter, including complex cases.
The last part of the manual focused on the evaluation
of the treatment, addressing the results obtained. A
CD-Rom was included, containing worksheets and
materials developed for the treatments.
Editors
ISBN
e-Book
: Y. Hiraku, S. Kawanishi, H. Ohshima
: 978-1-118-16030-5
: 978-1-118-82655-3
Book reviews
Multimorbidity refers to several co-occurring
long-lasting conditions affecting a given patient and
represents an increasing problem in our practice. It
makes our management strategies in some patients
challenging, particularly the elderly who develop a
range of medical problems, such as diabetes mellitus,
coronary disease, arterial hypertension, arthritis or
mental disorders.
Currently, all physicians, including urologists, have
become more and more specialized and can have the
tendency to narrowly view a patient, considering only
the disease that is related to their sub-specialty.
In this textbook, editors S.W. Mercer, C. Salisbury and
M. Fortin, focused on a very important “topic,” which
many of us may overlook. With the help of more than
20 worldwide experts they wrote a practical book that
addressed various clinical problems related to
multimorbidity in clinical practice.
This ABC series book is a practical resource that is
very useful to all physicians, regardless of their
specialty and level of practice. Readers will find in this
book information that will contribute to improving the
quality of multimorbid patient’s management.
Editors
ISBN
Publisher
Publication
Edition
Binding
Various other problems were also addressed,
Price
including the effects of multimorbidity on healthcare
Pages
resource use, the primary care management of
Illustrations
multimorbid patients, the role of healthcare electronic Website
The second part was dedicated to therapy and
presented as a manual which covered both bladder
and bowel training, including group therapy
techniques. The authors have chosen ‘training
programme’ as the term, although such a programme
represents more than a simple training. Various
exercises were included in a special course of
treatment, following the failure of standard therapy.
Individual training sessions and group sessions were
described. Seven sessions were addressed for bladder
training and two sessions were considered for bowel
training. The content of each session was exhaustively
described.
Undoubtedly, this outstanding textbook will be of
interest to all oncology researchers and to those who
want to update their knowledge. Although this
textbook was not intended for urologists, many will
find useful information related to urology. Trainees
and young researchers would also be attracted by the
book’s high quality.
ABC of Multimorbidity
Following a chapter that presented various definitions,
the authors described the epidemiological aspects of
multimorbidity, demonstrating its relationship with
increasing age. The effects of multimorbidity were
examined in the succeeding chapter, with emphasis
on the consequences of high morbidity burden on
functional status and quality of life.
The succeeding section was dedicated to
biochemistry. The authors focused on DNA damage
during inflammation. The role of DNA damage in the
development of cancer was discussed in various
tumours, including urological and non-urological
tumours. In the third section, the authors addressed
the main aspects of molecular biology in
inflammation related cancer. Various molecules such
as Toll-like receptors, inflammasome and micro-RNAs
were described and their role was discussed.
Specific causes of inflammation related cancers were
considered in the fourth part of the book, in which the
authors focused on some peculiar cancers and their
demonstrated or presumed cause. Most of them were
infections due to human papilloma, hepatitis and
Epstein Barr viruses and their role in cervical cancer,
hepatocellular cancer and nasopharyngeal cancer
were discussed. Other specific diseases were
addressed such as asbestosis and radiation-induced
injuries. The last section dealt with the prevention of
carcinogenesis in patients with chronic inflammatory
diseases. The authors also focused on various aspects
of colorectal cancer prevention.
medical record and computer-based technologies.
Mental health problems, whose prevalence is higher
in multimorbid patients, were addressed in a special
chapter. The authors also focused on healthcare policy
in the era of multimorbid patient’s management and
concluded their work with a chapter dedicated to
optimising patient’s management.
Price
: € 34.95
Pages
: 92 including CD-ROM
Illustrations
: 40 tables/fig. (109 colour
worksheets on CD ROM)
Original language : German
Website
: www.hogrefe.com
This manual is a compilation of the long experience of
the authors and provides the reader with an
exhaustive overview of elimination disorders. Many
pediatricians and pediatric urologists will find useful
information in this manual.
Authors
ISBN
E-book
Publisher
Publication
Edition
Binding
: M. Equit, H. Sambach,
J. Niemczyk, A. v. Gontard
: 978-0-88937-460-7
: 978-1-61334-460-6
: Hogrefe Publishing
: 2015
: 1st
: Softcover
- Astellas
European Foundation Award 2015
The Société Internationale d’Urologie and the Astellas European Foundation (AEF) are pleased to
sponsor a $20,000 USD award granted to a scientist of notable professional and ethical standing.
In preparation for the 35th SIU Congress, to be held October 15-18, 2015 in Melbourne, Australia,
the SIU and the AEF solicit nominations for this prestigious award. Nominations should include a
detailed curriculum vitae and a letter with a full explanation of the candidate’s merit, and must be
submitted to the Awards Committee, SIU-Astellas European Foundation Award 2015 c/o SIU
Central Office at the coordinates below no later than March 1, 2015.
The Awards Committee, appointed by the SIU’s Board of Chairmen, will review all applications and
announce the SIU-Astellas European Foundation Award 2015 laureate at the 2015 SIU Congress in
Melbourne.
Previous laureates were Dr. Donald S. Coffey (1994), Dr. Nils Kock (1997), Dr. Emil Tanagho (2000),
Dr. Alvaro Morales (2002), Dr. Michael Marberger (2004), Dr. Frans Debruyne (2006), Dr. Andrew
Novick (2007), Dr. Peter Alken (2009), Dr. Fritz Schröder (2011), Dr. Peter Scardino (2012),
Dr. Ralph Clayman (2013), and Dr. Urs Studer (2014).
Research Fellowship
The California Urology Foundation, in association with the Société Internationale d’Urologie,
announces the availability of a Research Fellowship for a fully- trained Urologist from Africa to do
research for one year in a medical laboratory of the University of California in San Francisco (UCSF).
This award is intended to prepare the candidate for an academic career in his or her home country;
a firm commitment to return will be a material consideration in the evaluation of candidates. This
fellowship carries a stipend of $50,000 USD, of which $14,000 is used to cover medical insurance and
administrative fees.
Applications for this fellowship will be evaluated by a joint SIU/UCSF Committee and should include
a proposed area of study, a detailed CV, and a minimum of 2 letters of professional references. An
application missing any of the items listed above will be considered incomplete.
The deadline for the January-December 2016 Fellowship will be February 28, 2015. Application
forms are available on the SIU website www.siu-urology.org under the Training Scholarships tab.
Applications can be submitted by mail, fax or e-mail to UCSF-SIU Research Fellowship c/o SIU
Central Office at the coordinates below.
SIU CENTRAL OFFICE
1155 University Street, Suite 1012, Montreal, Quebec, Canada H3B 3A7
Telephone: +1 514 875 5665 Fax: +1 514 875 0205 [email protected]
4134_SIU-AstellasUCSF_EUT_NovAd.indd 1
October/December 2014
: S.W. Mercer, C. Salisbury, M. Fortin
: 978-1-118-38388-9
: Wiley Blackwell
: July 2014
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: Softcover
: 26.30 €
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27
Preventing stone migration during intracorporeal lithotripsy
Two out of 10 kidney stone patients have ureteral calculi at time of diagnosis
Dr. Nicola Macchione
Clinica Urologica III,
Università di Milano,
A.O. San Paolo-Polo
Universitario
Milan (IT)
[email protected]
unimi.it
Prof. Emanuele
Montanari
Clinica Urologica III,
Università di Milano,
A.O. San Paolo-Polo
Universitario
Milan (IT)
emanuele.
[email protected]
The therapeutic options for ureteral stones, according
to EAU guidelines, include a conservative watch-andwait approach or active intervention. Usually, the
choice to follow one of these two options depends on
several factors related to stone size, density, location,
patient’s factors, surgeon capability, and equipment
availability.
The surgical approach includes extracorporeal shock
wave lithotripsy (SWL), retrograde uroteroscopy
(URS), percutaneous antegrade ureteroscopy and
open/laparoscopic ureterolithotomy. Although the
SWL approach is considered (in all cases where it is
not contraindicated) a good treatment option-- or by
many urologists as the gold-standard primary
treatment-- the introduction of new ureteroscopic
instruments, as well as the development of effective
intracorporeal lithotripsy methods, has increased in
the last years the use of the endoscopic approach as
first-line treatment (even if the difference of the
results between the two procedures in terms of
success rate and complication rate is not clear).
Anti-repulsion devices
In recent years, many instruments, strategies and
antirepulsion devices have been developed in the
field of endoscopic treatment of ureteral stones in
order to reduce the the retropulsion rate during the
laser/pneumatic lithotripsy. Anti-repulsion devices
that are currently available are divided as either
mechanical or gel-based. In the first group, these
include: Lithovac (Boston Scientific Corp., USA),
Stone Cone (Boston Scientific Corp., USA), Passport
Ballon (Boston Scientific Corp., USA), PercSys
Accordion (Percutaneous System, USA), NTrap (Cook
Urological, USA), and Xenx (Xenolith Medical,
Israel). The second group includes: BackStop gel
(Pluromed Inc., USA) and, in general, lubricating
jellies.
Many physicians have described experiences using a
stone basket like anti-repulsion device. The technique
consists in the use of a two-port adaptor attached to
the ureteroscope and insertion through that adaptor
of the laser fibre and the basket at the same time. In
that way, they are able to catch the stone with the
basket and then perform a laser lithotripsy while
avoiding bursting the basket’s wire. That technique
has many limitations linked to stone size and
location, and also looks less effective compared with
the use of a normal anti-repulsion device. Studies
have been described with baskets such as Escape
(Boston Scientific Corp., USA), Lithocatch (Boston
Scientific Corp., USA) and Parachute (Boston Scientific
Corp., USA).
Lubricating jellies
There are, at present, limited experiences in the
literature to suggest the safe and effective use of
lubricating jellies as anti-repulsion device, and the
few studies performed do not show results that
suggest its routine use. In many of them, the number
of patients treated is not enough to show a
statistically significant result and some studies lack
data with regards to details of the procedure such as
information on irrigant fluid.
An example is the follow-up randomised clinical
trial on the use of lidocaine jelly as an antirepulsion device during a pneumatic lithotripsy of
Currently, in literature, prospective studies comparing ureteral stone performed by Zehri et al. In that
study, the authors enrolled 50 patients and showed
the two modalities are limited. In a recent study
published in the Journal of Endourology by A. Kumar a significant difference in stone or stone fragment
migration for lidocaine-treated patients compared
et al., the authors performed a prospective
with controls, but they did not give any information
randomised trial comparing SWL and semi-rigid
ureteroscopy for upper ureteral stones less than 2 cm. regarding the location of the stone treated
(proximal or distal ureter) and the use of the
They enrolled 90 patients in each group, similar for
the stone characteristics, and they concluded that SWL irrigant fluid.
and URS are both safe and highly efficacious in the
More substantial is the literature on BackStop. It is a
management of upper ureteral stones < 20 mm. For
thermosensitive water-soluble polymer with reverse
upper ureteral stones < 10 mm, SWL is safer, less
invasive and of comparable efficacy as URS. For upper properties. It is liquid at temperatures below 16° C,
soft and injectable at room temperature and it
ureteral stones 10 to 20 mm, URS is more effective
becomes a viscous gel at body temperature. With a
and has a lower re-treatment rate than SWL.
ureteral catheter (3 or 5 F), it is delivered beyond the
stone(s) to form a temporary plug, preventing stone
Retropulsion of stone fragments
migration during the lithotripsy. At the end of the
Often the low success rate of the endoscopic
procedure, the plug is dissolved by cold saline
procedures is linked to the retropulsion of stone
irrigation.
fragments. It has been reported that 3-15% of stones
in the distal ureter and 28-60% of stones in the
A recent randomized controlled trial on the use of
proximal ureter undergo retrograde stone
retropulsion. In these cases it has been recorded that BackStop was published in the Journal of Urology by
there was an increase of operative time, the need for A. Rane et al. In that study, the authors enrolled 68
patients with a single stone in the proximal ureter
further ancillary procedures, a decrease of stoneand they showed a retropulsion rate of 8.8% in the
free rates and, as can be expected, an increase of
group treated with BackStop, versus a retropulsion
healthcare costs.
rate of 52.9% in the control group. No complications
have been reported in the BackStop group. In
Furthermore, stone/stone fragments retropulsion
conclusion, they said that BackStop appears to be a
could be associated with an increase of the risk for
novel, safe and effective means of preventing stone
urinary tract infections ( UTI), recurrent stone
formation and renal colic. The cause of the migration fragment retropulsion.
of the stone fragments depends on several factors,
There are various considerations with regards the
and are linked to the stone and ureter characteristics
Lithovac, which works the opposite way compared
such as the size and location of the stone and
with the former mechanical device. Lithovac is a
dilatation of the ureter, or related to the modality of
suction hollow probe combined with a pneumatic
the endoscopic procedure such as the pressure
probe, which is used during lithotripsy for fragments
generated by the irrigant fluid, insertion of the
aspiration, preventing stone migration. In literature,
instruments and laser burst.
there is only one study by F. Delvecchio et al.
published in the Journal of Urology. The authors
In addition, using pneumatic or electrohydraulic
enrolled 21 patients with ureteral calculi. They
lithotripters, the stone migration rate reported in
reported a 95% stone-free rate and in just one case
literature is much higher if compared with the laser
did a stone migration occurred. They used a
lithotripsy. These results suggest that the energy
source used for lithotripsy of ureteral stones is also an semi-rigid ureteroscope with a diameter of 8.5 F to
accommodate the Lithovac equipment, and in order to
important factor to consider in the endoscopic
reach the stone they performed a balloon dilatation of
treatment of the urinary stones to decrease the
the ureteral orifice to 15 F in 7 cases (33.3%). The
retropulsion rate.
advantage reported was that the use of a suction
during the lithotripsy improved stone clearance and
EAU Section of Urolithiasis (EULIS)
also the vision.
28
European Urology Today
Anti-repulsion devices
One of the most extensively studied anti-repulsion
devices is the Stone Cone. It is made of an inner wire
that lies in an outer radio-opaque carrying sheath.
The inner wire is divided into three parts: the floppy
tip, the cone, and the proximal part. During the
introduction into the ureter, the cone portion lies
inside the carrying catheter and is straight. Handling
the device from the distal part on the carrying
catheter, it is easy to deploy the cone. The cone size is
available in two different sizes of 7 or 10 mm, and the
coil portion diameters can also be adjusted according
to the ureteric diameter.
Since 2001, many papers regarding the use of Stone
Cone as anti-repulsion device have been written. In
2009, a study was published by B.H. Eisner et al. in
Urologia Internationalis with the largest series of
patients treated in a single centre using a Stone Cone
during ureteroscopy. They performed a retrospective
review of medical records of 133 consecutive
ureteroscopic holmium: YAG laser lithotripsy
procedures in which the Stone Cone was used. The
stone location was proximal ureter for 53 calculi and
distal ureter for 80 calculi. They reported no calculus
retropulsion in 131 patients (98.5%) and no major
complications. The investigators also performed a
Medline search showing that, as reported by them,
the Stone Cone is efficient at preventing stone
migration during endoscopic treatment of ureteral
calculi.
Regarding the PercSys Accordion, there are many
studies made in vitro that showed the safety and
efficacy of this device, but just a single experience in
vivo is reported in literature. This device consists of a
sheath wire system with a diameter of 0.038 inches
with a 6 cm hydrophilic soft tip. It is introduced as a
guide wire and once its position has been confirmed
(under fluoroscopic or endoscopic control), the device
could be deployed forming a multifold polyurethane
film backstop of 7 or 10 mm.
Figure 2: Xenx with nitinol mesh fully deployed
mesh lies between two radiopaque markers, one on
the top of the other in the closed device. At the end of
the procedure the device could be close and used like
a normal guide wire.
Safety and efficacy of Xenx was evaluated by C.
Sarkissian in an ex-vivo porcine model reporting good
results. The first in vivo evaluation was done by E.
Montanari et al. The investigators evaluated the safety
and efficacy of the Xenx in 18 patients (recruited
across three European stone centres) who underwent
ureteroscopy and laser fragmentation. No
complications have been reported. Median operator’s
evaluation for Xenx property was good. In addition,
no case of retropulsion was recorded.
The same concept is employed with Passport, a
balloon anti-repulsion device. It is composed of a
noncompliant balloon mounted on a stainless steel
wire for one-step ureteroscopic placement. The
diameter of the inflated device is 0.038 inches. As a
normal guide wire it is inserted endoscopically and
placed beyond the stone under fluoroscopic control.
Once positioned the balloon is inflated in order to
avoid the passage of stone fragments. In literature,
there are few studies regarding Passport, with the
first published by Dretler et al. in 2000 in the
Journal of Endourology. The investigators enrolled 42
patients and showed a successful placement of the
balloon above the stone in 69% of the cases and
achieved a stone-free rate of 90%. According to the
authors, the Passport device lacks efficacy in more
dilated ureters (more than 12 F of diameter).
Moreover, the balloon is liable to puncture, so it
never should come in contact with laser or
pneumatic lithotripter probes.
A recent study was published in the Journal of
Endourology by J. Pagnani et al. The authors
prospectively evaluated and treated 21 patients with
distal ureteral stones. The patients were divided in
two groups, one treated with PercSys and the other
treated as control. They showed that the Accordion
device effectively occludes the ureter and prevents the
retrograde migration of stone fragments. We should
point out that all the patients treated in this study
were affected by ureteral distal stones, and usually for Cost-effectiveness
stones located in the distal part of the ureter the
In conclusion, overall results of literature showed that
retropulsion rate is really low.
all the devices tested decreased stone migration
compared to ureteroscopic lithotripsy without use of
Another mechanical anti-repulsion device is NTrap.
these devices. On the other hand, the use of devices
This device is composed of an inner wire and outer
could increase the cost of the surgical procedure, so
sheath catheter. The inner wire has a 7 mm umbrella the choice of the best option, in terms of costmade from tightly woven nitinol wires spaced
effectiveness, remains the goal of every urologist.
approximately 1 mm apart in the centre and 2 mm
apart at either end. Diameter is 2.8 F. In a recent
At first glance, it may look expensive to use an
meta-analysis study by H. Ding et al. and published in anti-repulsion device during the endoscopic treatment
the Journal of Endourology, the investigators
of the ureteral stone, but we should consider how
evaluated the efficacy and safety of NTrap studied in
much the stone-free rate would cost the healthcare
two randomised controlled trials and one-case control system in terms of ancillary procedures,
study including 456 patients. The meta-analysis
hospitalisation days, and all the attendant risks (UTI,
showed that patients who underwent ureteroscopic
renal colic, recurrence rate). Only considering one of
lithotripsy with the use of the NTrap demonstrated a
the ancillary procedures needed to reach the
significant advantage over those without the use of
retropulsed stones, such as the use of the flexible
the device in terms of stone-free rate, and that the
instruments, the cost of the procedure became
incidence of stone migration was significantly lower
completely different and much more expensive when
in NTrap treatment than without NTrap.
compared to the cost of the standard procedure plus
an anti-repulsion device.
Figure 1: Xenx device
Not yet widespread on the market but already
evaluated in vitro and in vivo is Xenx. The closed
device looks like a normal hydrophilic guide wire with
a tip of 0.038 inches and a shaft of 0.04 inches, 150
cm long (Fig.1) The tip is floppy and hydrophilic. It has
an inner wire and an outer sheath. Once its position
has been confirmed (under fluoroscopic control) the
device could be opened, shifting on the distal part the
outer sheath on the inner wire. During these
procedures in the distal part, a nitinol mesh with a
maximum diameter of 12 mm is deployed (Fig.2). The
Many authors demonstrated that flexible
ureteroscopes must undergo repair every five to 18
uses and flexible urteroscope repair may cost up to
$5,000. In a recent study published by M. Ursiny et al.
in the Journal of Urolog, the authors evaluated the
cost-effectiveness of anti-repulsion devices for
ureteroscopic lithotripsy. They constructed a decision
analysis model to compare the cost-effectiveness of
ureteroscopic lithotripsy with versus without an
anti-repulsion device. They evaluated the following
devices: NTrap, Lidocaine jelly, Stone Cone and
Back-stop and the average cost estimated for the
device was $278. Otherwise, the estimated costs of
secondary procedures needed to treat retropulsed
stones were estimated at $5,290 for SWL and $6,390
for ureteroscopy. They concluded that the use of
anti-repulsion devices are cost-effective for
ureteroscopic lithotripsy at a retropulsion rate greater
than 6.3%. In addition, they suggested that urologists
who perform this procedure should assess
retropulsion rates to determine whether these devices
would be beneficial in practice.
October/December 2014
EULIS launches new postgraduate workshops on urolithiasis
In 2014 the EAU Section of Urolithiasis (EULIS) has launched its new postgraduate workshops on
urolithiasis. The initiative, conceived and enthusiastically promoted by EULIS Chairman Kemal Sarica,
had intended to fill the gap between the two EULIS Congresses of 2013 and 2015.
EULIS Board
K. Sarica, Istanbul (TR)
Chairman
In the future, including the years when the convention is not held, EULIS will organise workshops in
different European locations. The workshops will have different formats and will feature lectures, live
surgery and hands-on sessions. The workshops aim to serve the needs of both urologists and
nephrologists interested in urolithiasis.
First two-day EULIS postgraduate workshop on urolithiasis held in Vienna
Prof. Christian Seitz
Medical University of
Vienna
Vienna (AT)
Dr. Christian Tuerk
Hospital
Rudolfstiftung
Vienna (AT)
[email protected]
[email protected]
wienkav.at
The first two-day EULIS post-graduate workshop on
urolithiasis was held in Vienna in June 2014 at the
Medical University of Vienna, represented by Prof.
Christian Seitz and the Hospital Rudolfstiftung
represented by Dr. Chistian Tuerk. It gave a
comprehensive overview of urinary stone disease,
N.P. Buchholz, London (GB)
J. A. Galan, Elche (ES)
G. Gambaro, Rome (IT)
T. Knoll, Sindelfingen (DE)
D.J. Kok, Rotterdam (NL)
J.M. Reis, SantosLisboa (PT)
R. Siener, Bonn (DE)
O. Traxer, Paris (FR)
A. Trinchieri, Lecco (IT)
R. Unwin, London (GB)
and the scientific programme covered the entire range
of urolithiasis management from epidemiology and
diagnosis to various surgical and conservative
treatment modalities, and a glimpse into future
developments. A distinguished line-up of speakers
presented lectures and video sessions. The
workshop’s compact programme allowed participants Christian Seitz (AT), Roswitha Siener (DE), Christian
to meet leading experts in urinary stone disease and
Tuerk (AT) and Michael Töpker (AT).
exchange ideas with them in lively debate sessions.
The participants learned from unedited video surgery
The workshop was conducted by internationally
demonstrations of rigid and flexible URS, prone/
supine PCNL including mini, ultra mini and micro
renowned faculty members led by EULIS, including
Professors Noor Buchholz (UK), Petrisor Geavlete (RO), PCNL. With around 75 participants it was possible to
Thomas Knoll (DE), Sven Lahme (DE), Palle Osther
hold intensive dialogue between participants and the
(DK), José Reis Santos (PT), Kemal Sarica (TR),
faculty during debate sessions.
Enthusiastic participants at second EULIS postgraduate workshop on stones in Milan
Prof. Emanuele
Montanari
Urology Clinic III
University of Milan
A.O. San Paolo-Polo
Universitario
Milan (IT)
held for the training of flexible ureteroscopy and
percutaneous nephrolithotomy, live demonstrations of
Doppler renal ultrasound for diagnosing renal calculi
by the twinkling artifact, demonstrations of software
for dietary evaluation of renal stone patients, and a
critical appraisal of several scientific articles on dietary
risk factors for kidney stones.
emanuele.
[email protected]
The next day featured live surgery demonstration of
flexible ureteroscopy by Olivier Traxer and perc,
ultramini-perc and micro-perc by Emanuele
Montanari. A parallel course was held on
epidemiological, genetic and nephrological aspects of
Dr. Alberto Trinchieri
A. Manzoni Hospital
Urology Unit
Lecco (IT)
renal stone disease. The workshop ended with a
session of unedited videos of difficult renal stone
cases presented by Giampaolo Zanetti and Ioannis
Kartalas Goumas of the Vimercate Hospital and Nicola
Macchione of S. Paolo Hospital in Milan.
For the social programme, the course participants
visited San Eustorgio, one of Milan’s oldest religious
buildings that keep holy relics attributed to the Three
Magi (The Three Wise Men) and with a fresco of
beautiful paintings from the 15th century. The church
is also known for its underground ruins of
Mediolanum, an ancient city of the Roman Empire.
EULIS Chairman Kemal Sarica, presenting his lecture
www.eulis15.org
[email protected]
ospedale.lecco.it
The second EULIS post-graduate workshop on
urolithiasis was held in Milan from 15-16 September
2014 and led by the chairmen Emanuele Montanari of
the University of Milan - San Paolo Hospital and
Alberto Trinchieri of the Manzoni Hospital of Lecco.
The two-day course gathered around 30 urologists
and 10 nephrologists interested in the management of
kidney stones. The first day featured a general session
with lectures on various aspects of pathogenesis,
diagnosis and treatment of urolithiasis, presented by
EULIS board members, namely, Kemal Sarica, Giovanni
Gambaro, Dirk Kok, Emanuele Montanari and Alberto
Hands-on training
Trinchieri. In the afternoon, hands-on sessions were
EULIS15
3rd Meeting of the
EAU Section of Urolithiasis
10-12 September 2015, Alicante, Spain
EAU Events
are accredited
by the EBU in
compliance with
the UEMS/EACCME
regulations
European
Participants of the 2nd EULIS Postgraduate Workshop
Association
of Urology
EAU Section of Urolithiasis (EULIS)
October/December 2014
European Urology Today
29
Young Urologists/Residents Corner
ESRU’s objectives in practice
The Belgian example
Dr. Vincent De
Coninck
NCO Belgium
President-elect ESRU
Belgium
Brussels (BE)
[email protected]
uzbrussel.be
Dr. Barbara Hermans
NCO Belgium
Membership, ESRU
Belgium
Leuven (BE)
[email protected]
hotmail.com
after financial statements, a secretary and another
member maintaining our database. Our PR officer
maintains not only our Facebook page but also
promotes our group to new residents. For instance,
the PR officer has introduced the Movember
competition in our social media pages, in which every
Belgian urology resident (male or female) can send
their pictures wearing or sporting a mustache. The
best picture wins a special poster during the poster
session on our national conference in December.
Each university in Belgium has a representative in the
ESRU. We try to divide these assignments to at least
one representative of a university for us to reach many
residents across the country.
topic and every year we choose various areas such as
functional urology, paediatric urology, oncology and
andrology. Professors and experts on each respective
subject discussed the latest updates. We end the day
with a reception and dinner, and invite the
participating residents to a party.
Activities
Our motivated team composes every year an
expanded offer of courses, seminars and other
workshops to enhance the quality and knowledge of
future urologists. In our meetings, we discuss the
gaps in our training and incorporate these into
courses and updates. Every representative of a
Belgian university has to organise a course every two
years in order to have at least three to four national
courses a year. This is illustrated with the Imaging
Course held in Brussels, which is described later in
this article.
The purpose of the course was to discuss the value of
different imaging techniques for a certain disease.
Prof. Braeckman, a urologist of UZ Brussel, discussed
the indications of ultrasonography in diseases of the
kidneys, bladder and prostate. He explained what
urologists should be able to see and do with the grey
scales images. Concerning ultrasound of bladder and
kidneys, he described the steps on how to recognise
masses, stones and explained how to place tubes in
case of hydronephrosis or a full bladder.
Imaging course
On a Friday afternoon in September 2014, ESRU
Belgium organised a four-hour imaging course in
urology. All Belgian residents were invited to the
University Hospital of Brussels (UZ Brussel), where
around 33 or a third of residents attended the
course.
Turning theory into practice
ESRU.be is the Belgian association of residents in
urology. We have the same goals as the ESRU in
Europe to help ensure optimal urological care in
Belgium. To do this we organise courses and
workshops to achieve a high standard of clinical care. Every year, we organise the Starters’ Package, a
laparoscopy course held in close collaboration with
Members of the ESRU.be team carry out their
the Belgian Laparoscopic Urology Group (BLUG) for
responsibilities which are assigned to them during
the fourth-year residents. The course is spread in four
our first meeting of the year in July. Our chairman is
modules over the year.
responsible for leading the meetings and organising
the Starters’ Package, an annual course on
Annually, we hold in December the ESRU session
laparoscopy for fourth-year residents. He is assisted
during the Belgian congress (BAU congress). During
by the chairman-elect, who will become chairman the this “How To” session, experts provide
following year. The latter is responsible for organising understandable explanations on how to do certain
the ‘ESRU.be Day,’ a day-long scientific programme
surgical procedures. The sessions end with the award
focusing on a particular subject in urology, and which for best poster. Belgian residents can send abstracts
provides young doctors to meet their experienced
and posters of research or case studies. The prize
colleagues.
aims to stimulate scientific work by residents and
publish their clinical cases.
We have a webmaster for our website (ESRU.be),
another officer responsible for guiding the
We end our academic year by organising the ESRU.be
organisation in the right direction, a member looking day. Led by the chairman-elect, we try not to repeat a
For prostate diseases, the indications and applications
of grey-scale ultrasound were explained. Transrectal
grey scale ultrasound is useful for BPH to measure the
extent of the intravesical obstruction, which aids
treatment decisions (medical or surgical). In prostate
cancer it is the first test following DRE and PSA, since it
allows a quick and useful evaluation of any induration
in the prostate, providing a guide for biopsies in cases
when PSA seems to be high for no clinically obvious
reason. Doppler, contrast, elastography and
HistoScanning were also discussed during the sessions.
Dr. De Visschere, a radiologist of UZ Gent, highlighted
the value of MRI in common prostate and kidney
diseases. He outlined the diagnostic accuracy of
multiparametric MRI for prostate cancer detection,
and described the usefulness of MRI in characterising
renal masses. He ended by evaluating this imaging
technique in assessing Peyronie’s disease or
urogenital fistula.
Over 20 kidney diseases that can be diagnosed by CT
were depicted in detail by Dr. De Brucker, a
radiologist of UZ Brussel. He summarised the causes
and pathophysiology of diseases and described how
to recognise them. By describing interesting cases,
the audience learned about the value of CT in
assessing patients with recurrent urinary tract
infections, renal trauma, congenital anomalies and
suspicious lesions of the kidney on MRI or
ultrasonography.
Finally, Dr. Puttemans, a radiologist of Saint Pierre
University Hospital, Brussels, shared his expertise on
scrotal ultrasonography, and discussed how to
interpret small testicular masses by looking at the
position (center versus periphery), the vascularisation,
the size and the amount of lesions.
After the theoretical part, all participants tested their
skills in ultrasonography on urological patients (See
photo). Diseases to be recognised were renal
tumours, kidney stones, spermatocoeles and small
hypoechoic testicular lesions. In one patient, a
computer-aided ultrasonography was performed to
detect a prostate cancer of about 0.75 mL.
Interested in our activities or an inspiration for your
own society? Visit our website for additional
information at ESRU.be
The New Portuguese Residents Society
What should be the role of national societies?
Dr. Ricardo Pereira e
Silva
ESRU Project Manager
Chairman
Portuguese Urology
Residents Society
Lisbon (PT)
[email protected]
gmail.com
one can’t reach people, then all the other objectives
one may want to achieve will be out of your reach.
Thereafter, we created our own internal regulations.
Although it is a time-consuming process, it helps to
carefully think about the real purpose of the society
and to remind all members of the main objectives,
including those who are members of the Executive
Committee.
All residents are aware of these internal rules and
were invited to present a list of five candidate
residents, including a chairman and a secretary,
which we consider sufficient to have an adequate
To raise the level of medical education in urology,
nationwide representation of our Portuguese trainees
residents must actively participate in discussing the
main issues and in finding solutions for problems and (nowadays slightly over 60) while maintaining a good
level of functionality.
needs of residents in Europe.
To do so and enable us to express our opinions, it is
essential that we first organise ourselves through
structured national societies that can help define the
global position of residents in that country. With the
increasing number of urology residents in Portugal
and the wide distribution of centres, communication
has become a challenge for residents, which affects
the effective discussion of these issues.
The Executive Committee mandate was for a
two-year period. Elections were scheduled so every
resident could vote and choose one of the lists
during an annual resident’s dinner. By doing this
we had a democratic selection of the committee in
an informal way, while at the same time we had the
opportunity to exchange ideas and improve social
links among us.
We started by gathering residents from various parts
of our country which were motivated to contribute to
the creation of the society. After a couple of meetings
to discuss on how to proceed, our first step was to
create an updated database of our residents so that
we could make official announcements and bring
more people into the project.
Full support
The full support that the Portuguese Urology
Association is providing us is essential not only for the
success of our society but also for its future activities.
Creating the national resident’s society within the
national association may be an advantage since we
can learn from the obstacles they have faced and
dealt with, enabling us to focus on essential
processes. Moreover, being recognised as part of the
National Urology Association allows an open and
active debate that includes various viewpoints from
consultants, young urologists and residents.
Even if it seems easy to create this database, our
experience in ESRU is that most of the countries, with
or without a resident’s society, still don’t have a
global and updated list of all residents. To reiterate, if
30
European Urology Today
Our Resident’s Society aims to be a consultative group
within the Portuguese Urology Association, with the
main goal of raising awareness regarding specific
national problems. Thus, we can help contribute in
raising the standards of urological education in our
country. We can also assign ESRU National
Communication Officers who can participate in the
discussions with other European residents.
an amazing experience since they came in touch with
residents from all over the country, allowing an
exchange of essential information.
We strongly encourage countries that still haven’t
created their own national residents society to
consider the benefits and take the first steps. ESRU
members can certainly provide support by sharing
lessons from their own experience. And for countries
The Portuguese National Association of Urology has
which already have urology resident’s societies,
also given us a time slot for a plenary session during actively recruiting active members and involving
their National Annual Congress. This year, we selected them in current and future projects should be a
post-residency career options as the main theme and priority.
invited young urologists to speak about academic and
non-academic career moves, as well as private
Even though it is a daunting task, it is worth the
effort. Involvement and commitment are certainly
practice and working overseas. These are priority
issues for us due to the growing number of specialists important. Knowing who we are and what we think
in Portugal.
can inspire residents to have an active voice in the
debate of how urological education can be further
Those who are participating in our project to create a improved based on the needs and concerns of the
new Portuguese Resident’s Society have found it to be residents themselves.
EUREP 2015 - Important
information for applicants!
From 2015 European participants in EUREP will no longer have their travel costs reimbursed.
This means that all selected participants must pay for their travel to and from Prague.
The EAU/ESU will continue to cover the cost of accommodation for European residents in a shared
room as well as the cost of the course (incl. lunches, coffee breaks).
October/December 2014
Young Urologists/Residents Corner
An excellent training experience in Belgium
Two-month fellowship in robot-assisted surgery in Aalst
Dr. Viliam Kubas
Vice-president,
Residency Section
Slovak Urological
Society
ESRU Representative
for Slovakia
Banska Bystrica (SK)
Prof. Mottrie is a wonderful mentor who explains
every step and discusses the procedures in a clear
and understandable manner. I assisted mostly in
robot-assisted radical prostatectomies and partial
nephrectomies. I especially appreciated taking part in
robot-assisted cystectomy since the Slovakian hospital
where I work has plans to start introducing the
robotic option soon.
[email protected]
What made my fellowship even more valuable was
the possibility to go to ORSI or the OLV Vattikuti
Robotic Surgery Institute, which is an impressive
training centre where I could practise what I've seen
at the operating theatre. ORSI is fully equipped and
there are two robot-assisted surgical simulators and
two daVinci Si Robots with a dual console. It‘s like
very modern operating room with the latest airseal
flow system and two anesthesia machines. I should
also mention the friendly environment with the very
professional and helpful staff members who all
contributed to the outstanding reputation of the
centre. Paul, the manager of ORSI, was also kind to
give me a lift to and from the institute.
You can imagine how excited I was when I received a
letter from the secretary of Prof. Mottrie confirming
that I was accepted for a surgical training fellowship
in January 2014. I was on my way to the mecca of
robotic surgery in Europe!
Aalst is a small town located halfway between
Brussels and Gent and is known for the Onze Lieve
Vrouwziekenhuis (OLV). The OLV has a long history
of innovative research and is considered one of
Belgium’s best-known medical facilities. The OLV
Hospital and its staff have earned a remarkable
reputation not only in Belgium but across the
world, particularly in cardiology, cardiovascular
surgery, neurological surgery and, of course,
urology.
am finally satisfied with the scores. I noticed the
improvement in my technique every day. I also set the
Da Vinci Si system with training instruments and
performed many simulated situations such as
anastomosis using plastic models, an exercise which is
difficult to access or perform anywhere else.
Robotic course
I was lucky since I had the chance to attend the official
basic robotic course in ORSI. The day-long course was
led by Luc, a very skilled mentor from Intuitive. The
training started with a discussion about the
programme. I was asked general questions about
docking and setting up a robot before an operation.
I then performed certain exercises with the simulators.
Luc evaluated my experience level so he could focus
on my weaknesses during the course. Meanwhile,
Kevin, another ORSI-staff member, provided a
pre-medicated pig and gave the anesthesia. When
everything was ready, we placed the trocars,
discussing every possible difficulty in a real case.
Based on protocol, I was asked to dissect tissue, use
the third arm or use coagulation just like in a real
A typical day at the ORSI started begins with a cup of
case scenario. Even though I had some experience
coffee and friendly chat. Afterwards I practise at the
with a robot, I never realised how many tips and
console, doing the exercises on the simulators. Those
tricks I did not know. The protocol steps advanced
who tried the simulator will surely know that although smoothly that, at the end, we still had time to do
there are easy exercises, there are also very tricky
some optional exercises. At the end of the day, I
The first day I arrived in the hospital, I was warmly
procedures. I focused on the complex procedures, and realised that I just performed my first robotic partial
welcomed by Prof. Mottrie who showed me the
because I had enough time I would only stop when I
and radical nephrectomies, which gave me a very
operating rooms. I also met with the team and other
wonderful feeling of accomplishment. The day ended
fellows who begun their training a few months before
with a final simulator exercise to assess the level of
me. The fellows came from various countriesimprovement after the course. For satsifactorily
Giacomo from Italy, Zach from London (and originally
completing the training, I recieved a certificate for
from South Africa) and Morgan from Australia. They
console surgeon.
were all very friendly and the enviroment was
certainly supportive.
Surgeons from all over the world come to ORSI for the
training as a console surgeon. As a fellow, I could
The hospital‘s operating days were Tuesdays and
observe these training courses and also interact with
Thursdays. Operations started at 8 am and the daily
the trainees which enabled me to build up on
routine would normally end by 6 pm at the earliest.
important theoretical knowledge. This also gave me
Due to our busy schedule, time flew by very quickly.
the opportunity to get to know many future console
After I was oriented about the procedures I started
robotic surgeons from many countries.
bedside assistance and helped in many procedures
which enabled me to better understand the anatomy
Just like other surgical techniques, adequate skill and
of the prostate, kidney and bladder.
experience are required from the surgeon and his
Me and the skilled ORSI staff members
I had the chance to attend the official basic robotic course in ORSI
team. The ORSI offers physicians and their teams the
opportunity to build the necessary expertise, such as
robotic surgery training on a daVinci robot, allowing
surgeons to share these new surgical techniques back
in their own hospitals. The basic idea is that a
learning curve is no longer acceptable, and that a
living human body should no longer be considered
for training purposes. ORSI offers the alternative in
the animal laboratory. Moreover, the robotic surgery
trainings are accredited by the European Accreditation
Council for Continuing Medical Education (EACCME),
providing CME points for medical specialists in their
home country.
When I returned to Slovakia I've brought with me
many new tips and practical insights. I shared with
my colleagues step-by-step segments or procedures
in doing robot-assisted radical prostatectomy, under
the supervision of my chief Dr. Balaz. Two months
after my fellowship in Belgium, I've performed two
real cases and the goal is to perform in more cases.
For young surgeons, Aalst is an extraordinary place
where one can train extensively in robot-assisted
surgery while experiencing Belgian culture and
hospitality. I would like to thank everyone who made
possible this rewarding experience, particularly Prof.
Mottrie and his staff for their warm welcome and
expertise.
ESUR Meeting examines research prospects, challenges
Experts and top researchers gather in Glasgow
Prof. Zoran Culig
Chairman
EAU Section of
Urological Research
Innsbruck (AT)
[email protected]
i-med.ac.at
Glasgow hosted the 22nd meeting of the EAU Section
of Urological Research (ESUR) from 9 to 11 October
which gathered researchers from leading European
laboratories and experts who lectured on and
discussed the latest developments.
Young researchers delivered short oral and poster
presentations on topics such as eipthelial to
mesenchymal transition, epigenetics in urological
disease, circulating tumour cells and tumour
metabolism. The role of stromal cells in promoting
epithelial to mesenchymal transition was highlighted
by Gabri Van Der Pluijm (Leiden, NL), who said that it
is necessary to develop therapies that block tumour
cell invasiveness and epithelial to mesenchymal
transition.
An example is a small compound OCD195 that inhibits
metastatic progression. There is an increased interest
in non-coding RNA (miRNA) in stem cells in prostate
cancer. The lectures in the first session have shown
that specific miRNA and transcription factors such as
ETS have a relevant role in the regulation of cellular
stemness. A large number of miRNA is involved in the
regulation of stemness as shown in the lectures of
G. Van Der Pluijm and G. Carbone (Bellinzona).
October/December 2014
One of the meeting's highlights was the presentation
of insights from the Cancer Genome Atlas project on
muscle invasive bladder cancer by Seth Lerner
(Houston, USA). 38 significantly mutated genes from
238 tumours were identified, four of which are
involved in epigenetic regulation in urothelium cancer.
(Glasgow). In the well-established Pten mutant mice
model, Dr. Ahmad has identified genes as potential
drivers in aggressive prostate cancer.
The poster sessions were well-attended and
prompted lively discussions, and have shown that
young ESUR researchers appreciated the feedback
coming from experienced colleagues and their
fellows.
Another attractive topic were studies on tumour
biology and circulating tumour cells. Although the
presence of circulating tumour cells was not
associated with clinical and pathological features,
determination of circulating tumour cells in bladder
cancer diagnostic has a value in survival prediction.
S. Riethdorf (Hamburg, DE) gave a very informative
lecture on this topic. Current studies have focused on
metabolism in urological cancers and highlighted the
role of cMyc and cdk4 in the regulation of tumour
metabolism (I. Mills, Oslo and L. Fajas Coll, Lausanne).
The cell cycle regulators trigger the metabolic switch
that is required by cancer cells to proliferate.
The excellent social programme included a welcome
reception at the Glasgow City Chambers followed by a
Scottish-themed evening with dinner and Ceilidh in
the Oran Mor. The ESUR is grateful to Prof. Hing
Leung, Meeting President (Beatson Institute and
University of Glasgow) for his organisational skills and
great efforts to secure funding.
From left: M. Knowles (ESUR Vice-Chair), E. Zwarthoff
(Dominique Chopin award winner), Z. Culig (ESUR Chair), J.
Ceraline (ARTP representative)
From left: G. Carbone (ARTP jury member), I. Ahmad (ARTP
award winner), J. Ceraline (ARTP representative), Z. Culig
(ESUR Chair)
We look forward to another exciting meeting to be
held in Nijmegen, the Netherlands, in September 2015!
Two highlights of the meeting were presentations of
the research awards. Professor Ellen Zwarthoff
(Rotterdam, NL) received the Dominique Chopin
Research Award for her contributions to urological
research, mentoring, successful acquisition of
research funds and contribution to European urology
research networks. Her award lecture examined the
development and validation of biomarkers for bladder
cancer. Her lecture also took up molecular alterations
in the pathway of fibroblast growth factor receptors.
The Association pour la Recherche sur les Tumeurs de Travel award winners during the ESUR Meeting in Glasgow,
la Prostate (ARTP) award was given to Dr. I. Ahmad
10 October 2014 – supported by the Movember Foundation
European Urology Today
31
Prostate stem cell research continues hunt for genetic clues
EAU-RF Career Development Programme backs PCa research
By Joel Vega
However, so-called “slow-cycling” stem cells will
retain the label, enabling their identification as
label-retaining cells, and their screening for
expression of different markers. Researchers not only
identified a candidate slow-cycling label retaining SC
population in the basal cell layer, but more
importantly they identified a candidate slow-cycling
SC population in the luminal cell layer.
With the backing of the EAU-Research Foundation
(EAU-RF), a Sweden-based researcher investigating
the characteristics of prostate stem cells in mouse
models has identified a stem cell population in the
prostate’s luminal cell layer.
Although there are many questions that have to be
resolved, the researchers have widened their goals as
Aside from the candidate prostate SCs, the researchers the study enters its second year, adding objectives
such as performing in vivo cell lineage tracing of
also identified cell surface receptors and nuclear
androgen receptor (AR) expression in the candidate SC candidate murine SCs and functional assays of
isolated human normal and malignant SCs, with the
populations, a finding that opens up the possibility
that AR expressing luminal SCs or stem-like cells could aim to better identify and characterise human CSCs
and biomarkers.
function as cancer-initiating cells in PCa.
The study has implications in the search for genetic
clues that could later help in targetting and in the
development of new therapeutics for prostate cancer
(PCa) particularly those tumours which are metastatic
or highly resistant to drug treatment.
“Recent research has suggested the existence of
cancer stem-like cells in prostate cancer, and that
such cells may be the culprit behind therapy
resistance and progression of the disease,” said Dr.
Jens Ceder, lead study investigator who is based in
Lund University and Skåne University Hospital in
Malmö, Sweden.
Dr. Jens Ceder
“It has also been suggested that tumour-initiating
cells of prostate cancers originate from adult stem
cells in the basal layer of the prostate, since rare cells
with a basal phenotypes survive castration in prostate
cancer patients,” he explained.
marker expression in the developing and adult prostate
identifies basal and luminal stem cell subpopulations,”
described findings of separate basal and luminal stem
cell populations in the mouse prostate.
Ceder recently presented the second-year results
during an abstract session at the 22nd Annual
Meeting of the EAU Section of Urological Research
(ESUR) recently held in Glasgow, UK.
The ongoing study, with funding from the EAU-RF
Career Development Programme, has completed its
initial aim to identify and characterise normal murine
candidate prostate stem cells. In Glasgow, Ceder’s
presentation titled “Label retaining and stem cell
EAU Research Foundation
are up-regulated/activated in these cells in prostate
cancer, and which may aid in prognosis, and perhaps
also in stratifying patients for different treatment, and
targets that could be druggable,” Ceder said.
The study used a process called label-retention to
identify the normal stem cells (SCs) in the mouse
prostate gland by using a label called
bromodeoxyuridine (BrdU), which is taken up by
dividing cells when the prostate is formed. Later, the
BrdU label is washed out in rapidly growing transit
amplifying cells.
Stem cells
“We have used a very robust method for identifying
tissue stem cells that takes advantage of the relatively
quiescent nature of stem cells, in which cells are
pulsed with the BrdU,” explained Ceder.
That finding supports current scientific theory which
suggests that tumour-initiating cells of prostate
cancers originate from adult stem cells, but it has
remained controversial whether luminal SC exists in
addition to basal SCs.
“Our goal is for the studies to open up for the
development of new therapeutics. It is beyond the
scope of this study for any kind of clinical investigation
at this stage,” added Ceder when asked if he is
optimistic of a breakthrough outcome. “But we have
indications that some of the markers we have
identified will aid in future prognostics of prostate
cancer, and that the pathways found downstream of
these markers can be targeted, and naturally we
intend to investigate this during the coming year.”
“But translating the results from mouse to human
being is perhaps the biggest obstacle since there are
differences that should not be ignored. Therefore,
human samples are of utmost importance…Moreover,
it is extremely important to validate the data in
human material, especially so in advanced disease,”
added Ceder.
Development programme
The EAU-RF Career Development Programme, which
is funding innovative studies in basic science, exerts
efforts to bridge basic and translational research,
while aiming to provide a platform for talented
researchers to pursue pioneering research.
Aside from its direct support to novel studies, the
programme also hopes that its pool of researchers are
ably supported in developing their career goals. The
With scarce SC markers and experimental assays for
functional studies, researchers still faced obstacles in EAU-RF links up with both medical and academic
institutions in identifying promising talents and
investigating the cancer stem cells (CSC) theory. The
research work that deserves support. Supporting
preliminary data also suggest that one of their
candidate SC markers is up-regulated in advanced
Ceder’s study are their partners and collaborators at
the Radboud University in the Netherlands and the
disease.
University of York’s YCR Cancer Research United in
“We are working on identifying pathway-proteins that the UK.
EUSP Clinical Visit
A comprehensive and rewarding training in Braga, Portugal
Dr. Antonio Cicione
Magna Graecia
University
Catanzaro (IT)
electromagnetic kidney puncture system1. Likewise,
the Braga Hospital’s Urology Department routinely
offers 3D laparoscopic surgery to perform advanced
laparoscopic procedures, including radical cystectomy
with intracorporeal urinary diversion. Its emphasis on
technology is among the centre’s many activities that
make this institution attractive to a young urologist.
The hospital has the following features and facilities:
[email protected]
• A science laboratory where all the
endourological/laparoscopic equipment and
pelvic trainer boxes can be used. As Prof. Lima
has said: “If you have an idea- any idea- you can
immediately test it in our laboratory”;
• Uro-oncological surgery is performed principally
using laparoscopy. Furthermore, as a tertiary
centre in northern Portugal, many procedures for
stone disease are performed every year, including
extracorporeal lithotripsy, flexible and semi-rigid
ureteroscopy and percutaneous renal lithotripsy,
procedures which are done almost on a daily
basis.
• A friendly and professional environment for
trainees. Each surgical procedure was explained
by Prof. Lima and his team in a step-by-step
manner, allowing me to fully understand any
aspects of the procedures we were performing. In
a very short time I gained more experience and
confidence with urological laparoscopic surgery
and percutaneous renal surgery. I also often used
laser lithotripsy with flexible or semi rigid
ureteroscopy.
From April 1 to July 14, 2014 I had a three-month
clinical visit under the auspices of the European
Urology Scholarship Programme (EUSP) at the Braga
Hospital, Universidade Do Minho Life and Science
Research Institute in Braga, Portugal.
Braga, one of Portugal’s largest cities and located in
the northern Minho region, is known as “Portuguese
Rome” due to its history and the many Catholic
churches built in the city. And just like other university
cities in Europe, the city has a lively cosmopolitan
atmosphere with English widely spoken by local
residents.
A leading and well-equipped centre, the Braga
Hospital is a tertiary academic hospital with 12
operating theatres and a 705-bed capacity. The
hospital was recently opened and built according to
the newest standards of healthcare architecture. Prof.
Estevao Lima, an active member of the EAU Section of
Uro-Technology’s (ESUT) expert panel, chairs the
hospital’s Urology Department. A joint venture was
established between this new hospital and the
Universidade Do Minho Life and Science Research
Institute where every physician has the opportunity to
participate in pre-clinical hands-on training and to
actively participate in several research projects in a
fully equipped animal laboratory with the latest
technology available.
For instance, before my visit, Prof. Lima and his team
had successfully conducted a research on a new
European Urological Scholarship Programme Office
32
European Urology Today
A “friendly” picture with Prof. Lima (lower left) and his team
in Braga
A and B: views of Life and Science Research Institute at Universidade do Minho; C and D: Endourological laboratory hosted
in the Institute
• A multi-disciplinary collaboration that enhances
the training. Once a week, an oncological meeting
is scheduled to discuss the optimal treatment
option for borderline patient cases.
Radiotherapist, oncologist and a urologist take
part and present their viewpoints. Furthermore,
the whole urology team conducts a weekly
discussion of a singular case and takes a common
decision regarding treatment options. Finally, a
monthly research meeting is organized at the
department, together with engineers and
biologists, to update the participants on current
research and suggest a new topic.
I certainly had the opportunity during this threemonth visit to improve my surgical curriculum by
taking part as first or second surgeon in many
surgical procedures and while expanding my overseas
contacts. My gratitude to the EAU and the EUSP board
for this wonderful opportunity and to Prof Estevão
Lima and his team, including the nurses and
administrative workers, for their hospitality, and for
the experience that surely reflected the EUSP’s goal:
enhancing skills and cooperation through European
schooling.
Reference
1. Rodrigues PL, Vilaça JL, Oliveira C, Cicione A, Rassweiler
J, Fonseca J, Rodrigues NF, Correia-Pinto J, Lima E
Collecting system percutaneous access using real-time
tracking sensors: first pig model in vivo experience. J
Urol. 2013 Nov; 190(5):1932-7.
October/December 2014
NIMBUS trial re-opens in Germany, starts in The Netherlands
A European multi-centre prospectively randomised Phase III clinical trial in high grade NMIBC patients
Dr. Wim Witjes
Scientific and Clinical
Research Director
EAU Research
Foundation
Arnhem (NL)
[email protected]
uroweb.org
Dr. Raymond
Schipper
Clinical Project
Manager
EAU Research
Foundation
Arnhem (NL)
[email protected]
uroweb.org
National Coordinators: Marc-Oliver Grimm, Antoine
Van Der Heijden, Hugh Mostafid, Luis MartinezPiñeiro, Marko Babjuk, Levent Turkeri
The NIMBUS trial assesses whether a reduced
number of BCG instillations is not inferior to standard
number and dose intravesical BCG treatment in
patients with high grade non-muscle invasive
bladder cancer (NMIBC).
The target is to enrol 1000 patients with high grade
Ta-T1 urothelial carcinoma of the bladder with or
without CIS and who did not receive any BCG
intravesical instillation therapy from urology
departments in European hospitals participating in
this study. The EAU Research Foundation (EAU-RF) has
started this European study in patients who undergo
intravesical BCG treatment for their non-muscle
invasive bladder (NMIBC) cancer. The study is titled:
Treatment of High Grade Non-Muscle Invasive Urothelial
Carcinoma of the Bladder by Standard Number and Dose
of Intravesical BCG Instillations versus Reduced Number
of Intravesical Instillations with Standard Dose of BCG. A
European Association of Urology Research Foundation
Prospectively Randomised Phase III Clinical Trial.
(NIMBUS)
NIMBUS started in Germany in 32 centres with a grant
from the German Cancer Fund. Randomisation was
put on-hold temporarily due to the lack of availability
of BCG Medac. This situation is expected to change in
November/December 2014 whereafter randomisation
efforts can be resumed. In the Netherlands, the first
centres are now initiated and the first 2 patients were
randomised. In the UK and Spain we have performed
a feasibility that showed there is much interest to
participate in this EAU-RF project. In the UK, grant
applications are being prepared and the expectation
is that it is likely that we can start the project next
year in 20 to 25 UK centres. Also in Spain,
preparations are ongoing to start next year in
approximately 15 centres. Possibilities to cooperate
and start up in other countries like Czech Republic,
Turkey, France and Italy are currently being evaluated.
The primary endpoint for inferiority analysis is
time-to-first-recurrence. The secondary objectives are
to identify if number and grade of recurrent tumours,
rate of progression to a higher stage (T2 or higher) of
the disease and safety, specifically the presence of
treatment related toxicity > grade 2 differ between the
two study arms. The objectives of a cytokines sub-study
and a DNA sub-study- studies that will take place in
selected centres only- are to evaluate the impact of
therapy on cytokines and to evaluate the results of DNA
analysis as a prognostic factor, respectively.
Rationale
Intravesical instillation of BCG is a widely accepted
strategy to prevent recurrence of non-muscle invasive
bladder cancer. The most accepted treatment schedule
is induction of BCG: weeks 1 through 6 plus
maintenance (weeks 1,2,3) at months 3,6 and 12, but it
is unknown how many administrations are really
necessary. Scientific evidence supports the hypothesis
that after an initial sensitisation to BCG antigens has
occurred, the number of instillations can be reduced
for a proper anamnestic immune response resulting
in similar clinical efficacy and potentially less
side-effects and costs.
EAU Research Foundation
Study Design
This is a multicentre prospective, randomised,
parallel group, not blinded, trial to compare the
efficacy and safety of two different adjuvant
treatment schedules:
1) Induction cycle BCG-full dose; weeks 1 through
6 plus maintenance cycles at months 3, 6 and
12 (wks 1,2,3); total 15 full dose BCG
instillations
2) Induction cycle BCG-full dose (reduced
frequency); weeks 1,2, and 6 plus maintenance
cycles at months 3, 6 and 12 (wks 1,3); total 9
full dose BCG instillations.
10. Presence of active tuberculosis, any form of
immunodeficiency (e.g., HIV + serology,
transplant recipients) and/or any other
contraindication of BCG therapy
11. Patients with a WHO performance score of > 2
or ASA grade 4-5
12. Patients who have received any systemic
cytostatic agents within the last 3 months
13. Patients older than 80 years of age
14. Patients with uncontrollable UTI
15. Patients with White Blood Count (WBC) below
3.0 x 109/l or platelet count below 100 x 109/l
at baseline
16. Renal and hepatic function values
BCG intravesical instillation therapy is registered as
adjuvant treatment for the prevention of recurrence
of NMIBC and can be considered as standard
treatment for the type of patients requested in this
trial. For each individual centre, one of the three
locally available BCG strains in Europe will be
used: BCG Tice, BCG Medac or BCG Connaught.
• Levent Türkeri, Istanbul
• Marc-Oliver Grimm, Jena
• Wim Witjes, Arnhem
Study status
As of press time (cut-off date 28 October 2014),
30 centres are initiated in Germany of which 7 sites
randomised, in total, 12 patients. The Clinical Studies
Coordination Centre at the University Clinic in Jena is
coordinating the activities to enable the German
participants to include their patients. In the
Netherlands (approval of the study by the central
After the first transurethral resection (TUR),
according to the EAU Guidelines, patient undergoes ethical committee was obtained in October 2014)
13 centres will be initiated before the end of 2014.
a re-TUR 6 weeks (between 4-8 weeks) after the
The EAU Central Research Office is currently active in
complete resection. Patients with histological
the initiation of Dutch centres.
detection of high grade NMBIC in the re-TUR who
undergo a second re-TUR are eligible for the study
Study team
if they fulfil all selection criteria, i.e., patients
Protocol Writing Committee
should be macroscopically tumour-free. If so, first
• Marko Babjuk, Prague
re-TUR is considered as TUR as defined by the
protocol. Treatment with the randomised treatment • Luis Martinez-Pineiro, Madrid
schedule will start 2 weeks after and no later than • Joan Palou Redorta, Barcelona
• Anup Patel, London
6 weeks after the last resection (re-TUR).
The first maintenance therapy should be given 3
months (12 weeks) after the last instillation of the
induction BCG cycle (week 6) and hereafter at
months 6 (24 weeks) and 12 (48 weeks) after the
last instillation of the induction BCG cycle. Standard
Dose Instillations will take place with 1 vial of BCG.
The weekly BCG instillations during induction and
maintenance cycles have to be conducted within 7
± 2 days. Follow-up cystoscopy and cytology will
be done every 3 months in the first 2 years and
bi-annually until the fifth year.
Study population
Inclusion Criteria:
1. Presence of high grade (Ta-T1) urothelial
carcinoma of the bladder with or without CIS
1.1. Tumours can be primary or recurrent
1.2.Tumours can be single or multiple
2. Re-TUR should be performed at weeks 4-8
after initial resection, which must include
the deep resection or cold cup biopsy (deep
enough to obtain muscle tissue) of the
initial tumour site(s)
3. All visible tumours must be completely
resected
4. Early postoperative (within 6 hours of
resection) single-dose chemotherapy is
allowed after the first resection. However,
it should not be given after re-TUR if the
patient is considered eligible for this study
5. Prior multi-instillation intravesical
chemotherapy is allowed, provided that the
last instillation was completed 3 months
before randomisation in this study.
6. Signed and dated informed consent form.
Exclusion Criteria:
1. Any previous intravesical BCG therapy
2. Presence of primary CIS only.
3. Presence of histopathologically proven
muscle invasive urothelial carcinoma of the
bladder at first or re-TUR surgical
specimens
4. Patients with incomplete resection of visible
tumours
5. Absence of muscle tissue in the re-TUR
specimen(s)
6. Presence of any upper urinary tract
tumours at any time
7. Presence of any other histological type of
resected tumour other than urothelial
carcinoma on the first or second resection
8. Presence of another malignancy other than
the basal cell carcinoma of the skin
9. Presence of pregnancy or lactation

Study Principal Investigators
• Levent Türkeri
Marmara University Medical School –
Istanbul, Turkey
• Marko Babjuk
Charles University 2nd Faculty of Medicine –
Prague, Czech Republic
National Coordinators
• Germany: Marc-Oliver Grimm, Jena
• The Netherlands: Antoine Van Der Heijden
• United Kingdom: Hugh Mostafid
• Spain: Luis Martinez-Piñeiro
• Czech Republic: Marko Babjuk
• Turkey: Levent Türkeri
• France: Marc Colombel
• Italy: Andrea Tubaro
EAU Research Foundation
Wim Witjes, Scientific and Clinical Research Director
Raymond Schipper, Clinical Project manager
Christien Caris, Clinical Project manager
Sheik Nurmohamed, Clinical Project/data manager
Ria Janzing, Clinical Research Associate
Joke Van Egmond, Data manager
Arm 1 – N= 500
Inducon Cycle - Full Dose
Total 15 full dose BCG
Insllaons
N = 1000
High Grade Non-Muscle In-
Study Duraon:
2-year recruitment
RANDOMIZATION
vasive Bladder Cancer
3-year observaon
Arm 2 – N= 500
Inducon Cycle - Full Dose
(Reduced Frequency)
Total 9 full dose BCG Ins llaons
Lageübersicht Prüfstellen – NIMBUS - Studie













NIMBUS Centres in Germany: Green - centres with randomised patients, Blue - centres initiated, Red - Jena centre
Blauw zijn de sites die wel al geïnitieerd zijn maar nog geen patiënten gerandomiseerd hebben
October/December 2014
Groen zijn de sites die al patiënten gerandomiseerd hebben
European Urology Today
33
European Urology Forum 2015
Challenge the experts
7-10 February 2015, Davos, Switzerland
Saturday, 7 February 2015
Sunday, 8 February 2015
16.10 – 16.15 Opening and welcome
C.R. Chapple, Sheffield (GB)
J. Palou, Barcelona (ES)
07.30 – 08.45 An update on medical urology for the
urooncologist
Chair: N. Clarke, Manchester (GB)
Participants:
P-A. Abrahamsson, Malmö (SE)
C. Stief, Munich (DE)
M. Wirth, Dresden (DE)
16.15 – 18.00 What is new in urology 1
Chairs: C.R. Chapple, Sheffield (GB)
J. Palou, Barcelona (ES)
16.15 – 16.35 Functional urology
P. Abrams, Bristol (GB)
16.35 – 16.55 What’s new in renal cancer
H.G. Van Der Poel, Amsterdam (NL)
16.55 – 17.15
Recent developments in laparoscopy
A. Breda, Barcelona (ES)
17.15 – 17.35
What is new in endourology
E. Liatsikos, Patras (GR)
17.35 – 18.00 Prostate cancer
A. Bjartell, Malmö (SE)
08.45 – 09.00 Coffee break
09.00 – 11.00 Urological challenge
Chair: F.M.J. Debruyne, Arnhem (NL)
Challengers:
J. Dobruch, Warsaw (PL)
H. Hashim, Bristol (GB)
S. Hruby, Salzburg (AT)
O. Rodriguez Faba, Barcelona (ES)
S. Tyritzis, Athens (GR)
11.00 – 11.30
18.00 – 18.10 Coffee break
18.10 – 19.30 What is new in urology 2
Chair: J. Palou, Barcelona (ES)
18.10 – 18.30 Erectile dysfunction
W. Aulitzky, Vienna (AT)
18.30 – 18.50 Bladder cancer
N. Clarke, Manchester (GB)
18.50 – 19.10 Paediatric urology
J.M. Nijman, Groningen (NL)
19.10 – 19.30 Screening and treating prostate
cancer in the elderly
J.C. Hu, LA (US)
11.30 – 15.30
“Minimally invasive percutaneous stone
therapy: MIP 2.0 XS, S, M + L,
Downsizing is not enough”
U. Nagele, Hall inn (AT)
Industry sponsored
Video session 1
17.00 – 19.00 Hands-on training on URS
Tutors:
A. Breda, Barcelona (ES)
J-T. Klein, Heilbronn (DE)
T. Knoll, Sindelfingen (DE)
P.J. Osther, Fredericia (DK)
Industry sponsored
18.00 – 19.15 Urological challenge
Chair: F.M.J. Debruyne, Arnhem (NL)
Monday, 9 February 2015
08.15 – 08.45 Complications of mesh and how to
manage them
C.R. Chapple, Sheffield (GB)
08.45 – 09.00 Coffee break
09.00 – 11.00 Urological challenge
Chair: F.M.J. Debruyne, Arnhem (NL)
11.00 – 15.30 Video Session 2
16.00 – 16.30 Critical evaluation of minimally invasive
surgery for renal oncology
J.C. Hu, LA (US)
16.30 – 17.15
16.00 – 16.45 Update on new interventional
management of urolithiasis
ESWL – J. Rassweiler, Heilbronn (DE)
URS – K. Sarica, Istanbul (TR)
PCNL – T. Bach, Hamburg (DE)
16.45 – 17.45 Functional urology cases
Chair: P. Abrams, Bristol (GB)
Participants:
D.M. Castro Diaz, Santa Cruz de Tenerife
(ES)
C.R. Chapple, Sheffield (GB)
17.45 – 18.00 Coffee break
How to avoid complications and deal
with them with radical prostatectomy
Moderator: W. Artibani, Verona (IT)
Participants:
A. Bjartell, Malmö (SE)
J. Palou, Barcelona (ES)
C. Stief, Munich (DE)
17.15 – 17.45
Testosterone replacement therapy –
a contemporary update on its use in
clinical urology
W. Aulitzky, Vienna (AT)
17.00 - 19.00 Hands-on training on URS
Tutors:
A. Breda, Barcelona (ES)
J-T. Klein, Heilbronn (DE)
T. Knoll, Sindelfingen (DE)
P.J. Osther, Fredericia (DK)
Industry sponsored
17.45 – 18.00 Coffee break
18.00 – 19.15 Urological Challenge
Chair: F.M.J. Debruyne, Arnhem (NL)
Tuesday, 10 February 2015
07.30 – 08.15 Update on bladder cancer management
Chair: C. Stief, Munich (DE)
Participants:
J. Palou, Barcelona (ES)
N. Clarke, Manchester (GB)
08.15 – 08.45 Adjunct therapy for prostate cancer – has
this come of age?
P-A. Abrahamsson, Malmö (SE)
08.45 – 09.00 Coffee break
09.00 – 11.00 Urological challenge
Chair: F.M.J. Debruyne, Arnhem (NL)
11.00 – 15.30 Video session 3
16.00 – 16.30 Personalised medicine – an important
new direction for urology
W. Artibani, Verona (IT)
16.30 – 17.00 Translational research in oncology
Chair: N. Clarke, Manchester (GB)
Participants:
A. Bjartell, Malmö (SE)
J.C. Hu, LA (US)
H. Van Der Poel, Amsterdam (NL)
17.00 – 18.00 Paediatric cases
J.M. Nijman, Groningen (NL)
18.00 – 18.15 Coffee Break
18.15 – 19.30 Urological challenge
Chair: F.M.J. Debruyne, Arnhem (NL)
EAU and partners: synergies
Collaborative partnerships enable EAU to pursue goals
Prof. Chris Chapple
EAU Secretary
General Elect
Chairman, EAU
International
Relations Office
[email protected]
sheffield.ac.uk
The ethos of the European Association of Urology
(EAU) is to work closely with all the European
national associations to promote and advance
urological practice. In this context, the EAU
collaborates closely with a number of patient
organisations to achieve this aim. It is also
particularly important to work with the European
Commission to fulfil this goal and to help represent
the interests of our partner national associations
within Europe.
We have continued to further expand our ongoing
educational and scientific activities within Europe.
Following on from the enormous success of our
annual meeting in Stockholm, preparations are well
advanced for the forthcoming meeting in Madrid. In
addition to the scientific congress activities, more
about which you will be reading on our website in
the next few months, we also organise the incredibly
successful residents training meeting (EUREP) which
has now been held for 13 consecutive years and at
which 350 residents in the final stages of their
training attend.
This is just a sample of the wide range of activities
which are ongoing including the activities related to
the enormously successful Guidelines publications
which are available to all members and can be
The EAU has had a number of very successful
downloaded and utilised not only in their long form
meetings which have been held at a national and
pan-national level within Europe and beyond over the but also in the abridged version with an
last nine months. We recently had a very successful
meeting with our colleagues in Russia at the Russian
Society of Urology Congress in Saratov. The Société
Internationale d'Urologie (SIU) meeting was recently
held in Glasgow and the strong collaboration between
EAU and SIU was exemplified by the EAU session at
this meeting and the strong participation of EAU
members.
The EAU is continuing to strengthen its close
interaction with fellow urologists across the globe as
emphasised by the number of teaching activities
which we have participated in, such as the EAU
joining in with the Asian Society of Urology meeting
held on Kish Island from 5 to 9 December.
In addition, we recently held the 11th meeting of the
European Robotic Urology Section (ERUS) in
Amsterdam, under the auspices of the EAU, with over
700 attendees. Another major event is the European
Multidisciplinary Meeting on Urological Cancers
(EMUC) of which the sixth edition was held in Lisbon,
Portugal in November, which attracted over 1400
attendees, and hosted an ICUD meeting on the
preceding Friday and and the 3rd Meeting of the EAU
Section of Urological Imaging.
34
European Urology Today
Under the auspices of the EAU Section of
Genitourinary Reconstructive Surgeons (ESGURS)
and in close collaboration with the European
Society for Paediatric Urology (ESPU), the first
ESGURS-ESPU meeting was held, tackling issues
in genito-urinary reconstruction particularly those
affecting adolescent and paediatric patients. On
the occasion of the Emirates Urology Society
meeting, the EAU collaborated with the society to
stage a comprehensive educational programme on
14-15 November and have further similar activities
planned for next year.
accompanying app which can be purchased for a
nominal fee.
The EAU Section Office organised successful projects
and their activities cover the whole area of
contemporary urology. The integration of all of our
activities and offices, including the Scholarship Office,
the Education Office (European School of Urology),
and the Scientific Congress Office, and the
participation of all EAU members with the strong
support of their national societies, exemplify the wide
and unified goals of our on-going educational
programmes within European urology.
Please make sure you have the date of the next
annual meeting in your diaries - 20-24 March 2015,
Madrid, Spain.
We look forward to meeting you there!
No one
succeeds
alone.
We are proud to be a part of a
hard-working, dedicated community. We know and understand
the importance of collaboration, of
sharing and building on the ideas of
others. That’s why we’re expanding
into social media platforms so that
we can increase interaction with and
within the community.
europeanurology.com
european
urology
Forward faster. Together.
european
urology
October/December 2014
Forward faster. Together.
Don’t forget to renew your EAU Membership!
A message from the Membership Office
Our members are the heart of the EAU. Their
knowledge, experience, and talents help to make the
EAU the vibrant community it is today. We would like
to thank you for your membership and your
contribution to our association. It helps us to
continuously improve urological practice, research
and education in order to raise the level of urological
care in Europe and beyond. Please pay your fees on
time in order to keep enjoying the benefits of EAU
membership.
Thanks to your support we were able to accomplish
many successes in 2014. Our major achievements of
last year are:
•Scholarships: The European Urological
Scholarship Programme (EUSP) supports young
and upcoming urologists and researchers
financially to stimulate clinical and experimental
research across Europe and to share of expertise
and knowledge exchange. This year we approved
5 scholarships, 3 visiting professor programmes, 1
short visit and 18 clinical visits.
•Guidelines: This year, besides EAU Pocket
Guidelines for iOS, we launched an Android
version as well. Both apps are free for members
and have been downloaded 4180 times in 2014.
• European Urology: Our official journal, is
currently read by more than 20,000 urologists
across the globe, recently received an Impact
Factor of 12.480, making it the leading scientific
publication in the field of urology. The European
Urology app, which was launched earlier this year,
was downloaded 2860 times.
What to Expect in 2015:
In this rapidly changing field we aim to offer you a
platform to keep you abreast with the latest
developments in urology, to prepare you for new
technology and to help you better serve your patients’
needs. For 2015 we are focussing on the following
innovations:
•Education: Easy access to quality education and
scientific resources is a top priority of the EAU.
That is why we are currently developing a
comprehensive online resource centre, which will
contain the best scientific content from our
meetings, innovative e-courses, top-notch
surgical videos and practical workshops to
improve your surgical skills. To be expected in
March 2015.
•Policy: Political initiatives impact urology
professionals and patients in various areas. For
2015 the EAU will focus on enlarging its influence
in the European politics and law-making to raise
the voice of the urological community.
• Patient Information: Patients are the driving force
and inspiration for all of our activities. This year
we will launch four new topics in EAU Patient
Information and we translated the existing Patient
Information into 10 different languages. For 2015
we plan to add several new topics in major
European languages.
Renew your membership!
We kindly remind all EAU members to pay their
membership fees for 2015 on time. In early November
we sent an e-mail invoice to all current members for
the 2015 fees (1 January – 31 December 2015). This
invoice has to be paid by 1 January 2015. Members can
pay by bank transfer, online with credit card through
MY-EAU or by direct debit. Please check your MY-EAU
account to ensure that we have your correct e-mail
address, as invoices and reminders will be sent by
e-mail.
In case the invoice is not paid on time, a reminder
will be sent, followed by a second reminder which
will include an additional €15 administrative fee.
Should the fees still not be paid, a third reminder
will be sent with another €15 administrative fee, for
a total of €30. If payment has not been received
after these reminders, membership will be
cancelled.
Should you wish to register for the 2015 Annual EAU
Congress, and your membership is cancelled, you
cannot make use of the membership discount. In
order to reactivate your membership, you will have
to pay the membership fee as well as the
outstanding costs amounting to around €45 to €75
(depending on your membership type). The EAU
offers its members the convenience of paying by
direct debit. A SEPA form will be made available
through MY-EAU which can be filled out, signed and
sent to the EAU by email.
The SEPA form can also be printed and sent by
post. This way, membership fees will be
transferred from your account automatically when
due, and you have no risk of additional
administrative fees due to delayed payment. This
option is available to members in the Single Euro
Payments Area (SEPA), which includes all EU
Help urologists
collect CME credits
and register your
activity today!
countries as well as Iceland, Liechtenstein,
Norway, Switzerland and Monaco.
Don’t miss the opportunity to renew your
membership!
Have you moved?
Changed name?
New employer?
(Inter)National Urological Associations and the
CME providers (organisers of CME activities) are
invited and encouraged to send in requests to
register nationally accredited CME activities or
requests for European accreditation.
Alter your personal
data on-line:
fast and easy -
www.eu-acme.org
www.eu.acme.org
UROLOGY WEEK 2014
Various events to increase awareness of urology and inform the public
Journée d’information
le 24 septembre 2014 de 9h à 18h à la Clinique Charcot – Sainte Foy-lès-Lyon
RASTREIOS GRATUITOS
NA REDE SAÚDE CUF
organised Urology Week events for the first time
“in itsWehistory.
It was also the first time Urology Week took
2014
Vážení mediální zástupci,
zveme Vás na tiskovou konferenci na téma:
Onkologická onemocnění v urologii, prevence,
jak je včas diagnostikovat a vyléčit,
novinky v diagnostice i léčbě
HIPERPLASIA BENIGNA DA
PRÓSTATA
INFORMEZ-VOUS !
Consultez un urologue
kterou pořádáme v rámci projektu European Association of Urology – Urology Week. Občanské
sdružení Europa UOMO CZ je českou odnoží Evropské koalice proti rakovině prostaty.
25. září 2014 od 10.00 hodin
národní Banka vín, platnéřská 4, praha 1 (vchod z ulice křížovnická 1)
program tiskové konference
Karcinom prostaty
prof. MUDr. Dalibor Pacík, CSc.
přednosta urologické kliniky FN Brno, předseda Europa UOMO CZ, člen International Prostate Health Council
Nádory ledvin
as. MUDr. Vítězslav Vít
vedoucí onkologické poradny urologické kliniky FN Brno LF MU
Nádory varlat
as. MUDr. Gabriel Varga, FEBU
vedoucí lékař JIP a UD poradny urologické kliniky FN Brno LF MU
Marque em
qualquer receção
ou através de
telefone
Nádory močového měchýře
as. MUDr. Vítězslav Vít
vedoucí onkologické poradny urologické kliniky FN Brno LF MU
DIA 27 SETEMBRO APOSTE NA PREVENÇÃO
O aumento do tamanho da próstata denomina-se hiperplasia ou hipertrofia
benigna da próstata. É uma das patologia mais frequentes em homens a partir
dos 50 anos e a sua prevalência aumenta com a idade.
CUF Infante Santo 213 926 100 • CUF Descobertas 210 025 200 • CUF Porto Hospital 220 039 000 • CUF Porto Instituto 220 033 500
CUF Belém 213 612 300 • CUF Alvalade 210 019 500 • CUF Torres Vedras 261 008 000 • CUF Cascais 211 141 400
Na závěr tiskové konference Vás zveme na malé občerstvení.
La Semaine de l’Urologie, du 22 au 26 Septembre, est une initiative de l’Association Européenne d’Urologie afin de sensibiliser le grand public aux différentes pathologies touchant les reins, la vessie, la prostate. Těšíme se na společné setkání!
Pořadatel:
V případě zájmu prosíme
o potvrzení Vaší účasti.
Eliška Kubátová – produkční
Forinel Trading SE,
Na hlídce 22, 130 00 Praha 3
Mobil. tel.: 733 710 382
E-mail: [email protected]
Záštita:
Organizátor:
Pod záštitou
MUDr. R. Krause, MBA, ředitele FN Brn
France, Clinique Charcot
An open day in Lyon with
urologists ready to answer
people’s questions
The Urology Week events organised by AUSA were not only
an initiative of urology professionals but patients groups
and the general public were also involved. The initiative
was widely promoted through posters and pamphlets
distributed by AUSA.
Pod záštitou
prof. MUDr. J. Mayera, CSc., děkana LF MU
www.saudecuf.pt
Portugal, Saúde Cuf
Free prostate screening in
all clinics and hospitals in
Portugal
place in Albania. The main event was called “Urologist for
a Day” – a fun, but highly educational initiative aimed to
create awareness about kidney cancer, bladder cancer, and
prostate cancer. The focus was on early detection of these
diseases.
Czech Republic, EUROPA
UOMO CZ
Organised a press
conference for its Czech
branch in Prague
A Urology Week rally in the centre of Albania’s capital,
Tirana, was a perfect way to attract the attention of both
the media and the general public. AUSA carried out a street
poll among bystanders, inquiring about their knowledge
of PSA tests and offering them information about it when
necessary. The opportunity for AUSA members to engage
with the general public face-to-face painted a clear picture
of the information level and helped to generate ideas for
follow-up initiatives.
In another event urologists provided free consultations
on kidney, bladder, and prostate cancer. The President
of AUSA, Prof. Kim, published several articles in local
newspapers and was interviewed by two important
national television channels. AUSA also helped to arrange
free PSA examinations. More than 350 men received a free
consultation.
Albania, Albanian Society of Urology
Organised Urological Week 2014, 11 symposia of Urology, 242 doctors participated
Find out more: www.urologyweek.org
October/December 2014
Finally, AUSA organised
an informative walk
against kidney cancer,
bladder cancer and
prostate cancer in Tirana
which gathered over 700
people – mostly men
with these conditions and their spouses. It was not
aimed to address the seriousness of the situation in
which cancer patients can find themselves, but this
event was dedicated to the positive outlook on life. It
stressed the fact that patients with these conditions can,
and should, be able to have the respect of society and
live a normal life.
”
By Prof.Ass.Dr.Kim Drasa - President AUSA
Albanian Urologists & Sexologists Association
Czech
ek activities of hospitals in the
Check the other Urology We
n, Poland,
ista
Pak
rg,
bou
em
Greece, Italy, Lux
Republic, France, Germany,
Kingdom at
in, Switzerland and the United
Portugal, Romania, Serbia, Spa
www.urologyweek.org
#urologyweek
European Urology Today
35
Congress calendar 2014/2015
December
11-12: Hall in Tirol, Austria
Minimally Invasive Percutaneous Stone Therapy
Clinical Workshop (MIP)
Contact: Dept of Urology and Andrology
Phone: +43 50 504 36310
Fax:
+43 50 504 67 36310
E-mail:[email protected]
11-15: Maastricht, The Netherlands
Pelvic Floor Neuromodulation advanced training
program
Contact: European Continuing Medical Training ECMT
Phone: +31 618099653
Fax:
+31 847413849
E-mail:[email protected]
Website:http://www.ecmt-training.com
12: Spa, Belgium
BAU2014: 14th edition of the annual congress of the
Belgian Association of Urology
Contact: e-HIMS bvba
Fax:
+32 3 491 8271
E-mail:[email protected]
Website:http://bau2014.be/
12-13: Aurassi Algiers, Algeria
10th Congress of Urology Algerian
Contact: Dr. Chawki Djeffal, General secretary
Algerian Association of Urology AAU
E-mail:[email protected]
14: Tbilisi, Georgia
National congress of the Georgian Association of
Urology
Contact: Prof. L. Managadze
Phone: +995 32 96 48 70
Fax:
+995 32 96 48 70
Website:www.gua.org.ge
14: ESU organised course on LUTS and
incontinence: Where is the truth? at the time of the
national congress of the Georgian Association of
Urology
Contact:ESU
18-20: Cairo, Egypt
17th Copenhagen Symposium on Endoscopic
Urological Surgery
Contact: International Conference Services ICS
Phone: +45 3946 0500
E-mail:[email protected]
Website:www.seus2015.com
Operative Skills in Urology: Modules 3 and 4
Contact: RCS Education
Phone: +44 20 7869 6300
E-mail:[email protected]
Website:https://www.rcseng.ac.uk/courses/
course-search/operative-skills-inurology-modules-3-4
February 2015
1-6: Caceres, Spain
Hands-on training skills programme on
Laparoscopy and Endourology
Contact:ESU
5-7: Rome, Italy
3rd Edition Global Congress on Prostate Cancer 2015
E-mail:[email protected]
Website:www.prosca.org
5-7: Copenhagen, Denmark
17th Congress of the European Society for Sexual
Medicine
Phone: +49 40 6708820
E-mail:[email protected]
Website:http://www.essm-congress.org
5-8: Ranchi - Jharkhand, India
48th Annual Conference of Urological Society of
India (USICON)
Contact: USICON 2014 Secretariat
Phone: +91 11 23404323
Fax:
+91 11 23360067
E-mail:[email protected]
Website:www.usicon2015.com
7-10: Davos, Switzerland
European Urology Forum 2015 – Challenge the
experts
Contact:ESU
Phone: +31 26 389 0680
Fax:
+31 26 389 0674
E-mail:[email protected]
Website:www.esudavos15.org
12-14: Doha, Qatar
19-20: Arezzo, Italy
19-20: Hall in Tirol, Austria
3rd Junior Users Meeting, To Begin and Progress
Urologic Robotic Surgery - EAU Endorsed
Location: San Donato Hospital
Contact: Prof. Filippo Annino
E-mail:[email protected]
Minimally Invasive Percutaneous Stone Therapy –
Clinical Workshop
Contact: Ms. Sabine Weinberger and
Ms. Miriam Faik
Phone: +43 50 504 36310
Fax:
+43 50 504 67 36310
E-mail:[email protected]
12th Meeting of the EAU Section of Oncological
Urology (ESOU)
Contact: Congress Consultants B.V.
Phone: +31 26 389 1751
Fax:
+31 26 389 1752
E-mail:[email protected]
Website:www.esou15.org
23-26: Belgrade, Serbia
1st International course on uro-genital
reconstructive surgery
Contact: Center for Genito-Urethral
Reconstructive Surgery
Phone: +381 11 2474 918/ +381 66 600 9902
Fax:
+381 11 2475 954
E-mail:[email protected]
[email protected]
Website:www.savaperovic.com
www.savaperovicfoundation.com
27: Copenhagen, Denmark
Pre-course in Robotic Surgery at the time of the
17th Copenhagen Symposium on Endoscopic
Urological Surgery
Contact: International Conference Services ICS
Phone: +45 3946 0500
E-mail:[email protected]
Website:www.seus2015.com
36
12-13: London, United Kindom
The 6th International Workshop for Vaginal Fistula
Repair and Female Urethral Reconstruction
Contact: Pan Arab Continence Society
Phone: +2010 5355353
Fax:
+20 2 2455 3443
E-mail:[email protected]
16-18: Munich, Germany
European Urology Today
www.uroweb.org
28-30: Copenhagen, Denmark
AUA Segura International Urolithiasis Course
Contact: Depts of Urology and Medical Education
at Hamad Medical Corporation
Phone: +91 268 2520248 or +974 4439 1864
E-mail: [email protected] or
[email protected]
Website:auasegura.hamad.qa
January 2015
Worldwide, continually updated urological meeting calendar at
20-27: Istanbul, Turkey
11th Pan Arab Continence Society Meeting in
collaboration with International Continence Society
Contact:PACS
Fax:
+2 24553443
E-mail:[email protected]
Website:http://www.pacsoffice.com/PACS/
26: London, United Kingdom
Urological Anatomy for Surgery course
Organiser:RCS Education
E-mail:[email protected]
Website:http://www.rcseng.ac.uk/courses
March 2015
4-8: Vienna, Austria
European Congress of Radiology (ECR2015)
Contact: European Society of Radiology (ESR)
Phone: +43 1 533 4064 0
Fax:
+43 1 533 4064 448
E-mail:[email protected]
Website:http://www.myesr.org/cms/website.
php?id=/en/ecr_2015.htm
6-8: Sudan, Sudan
The Third Academic Conference of SUA
Contact: Sudanese Urological Association
Website:www.sudaneseurology.net
20–24: Madrid, Spain
30th Anniversary EAU Congress
Contact: Congress Consultants B.V.
Phone: +31 26 389 1751
Fax:
+31 26 389 1752
E-mail:[email protected]
Website:www.eaumadrid2015.org
21-23: ESU Courses, HOTs, Education and
Innovation at the time of the 30th Anniversary EAU
Congress
Contact:ESU
21-23: Madrid, Spain
16th International EAUN Meeting
Contact: Congress Consultants B.V.
Phone: +31 26 389 1751
Fax:
+31 26 389 1752
E-mail:[email protected]
Website:www.eaumadrid2015.org/eaun
April 2015
11-14: Adelaide, Australia
68th Annual Scientific Meeting of the Urological
Society of Australia and New Zealand (USANZ)
Contact:USANZ
Phone: +61 2 9362 8644
Fax:
+61 2 9362 143
E-mail:[email protected]
Website:www.usanz2015.com
18-21: Kanazawa, Japan
103rd Annual Meeting of the Japanese Urological
Association
Contact: Secretariat 102JUA
Phone: +81 11 738 3503
Fax:
+81 11 738 3504
E-mail:[email protected]
Website:http://www.urol.or.jp/en/meeting.html
21-25: Acapulco, Mexico
39th Annual Meeting of CMU
Contact:CMU
Phone: +52 664 634 1138
E-mail:[email protected]
29-30: ESU organised course at the time of the
EAU Baltic Meeting
Contact:ESU
29 May–2 June: Chicago (IL), USA
American Society of Clinical Oncology (ASCO)
Annual meeting 2015
Contact:ASCO
Phone: +1 571 483 1300
E-mail:[email protected]
Website:www.asco.org/portal/site/ascov2
June 2015
10–11: Presov, Slovakia
National congress of the Slovak Urological
Association
Contact: Assoc. Prof. Ivan Mincík (President of
Slovak urological society)
Phone: +421 51 7722756
Fax:
+421 51 7722756
E-mail:[email protected]
11: ESU organised course at the time of the
national congress of the Slovak Urological
Association
Contact:ESU
15–18: Manchester, United Kingdom
Annual Meeting of The British Association of
Urological Surgeons (BAUS)
Contact:BAUS
Phone: +44 20 7869 6950
E-mail:[email protected]
Website:http://www.baus.org.uk
18–20: Kiev, Ukraine
Congress of the Association of Urology of Ukraine
Phone: +380 44 489 39 80
Fax:
+380 44 254 00 40 or +380 44 486 65 69
E-mail:[email protected]
19: ESU organised course on Prostate cancer at
the time of the national congress of the Ukrainian
Urological Association
Contact:ESU
24–26: Rome, Italy
2nd Edition Global Congress on Lower Urinary Tract
Dysfunction
Contact: Vita-Salute San Raffaele University
Website:http://lutd.org/
28-30: Paris, France
23–26: Antalya, Turkey
5th International Meeting “Challenges in
Endourology & Functional Urology” (CIE 2015)
Contact: Erasmus Conferences Tours & Travel S.A.
Phone: +30 210 7414700
E-mail: [email protected]
Website:www.challenges-endourology.com/
11th National Turkish Endourology Congress
Website:www.endouroloji2015.org
28–30: Ottawa, Canada
24–26: Beijing, China
4th International Forum on Frontiers in Urology
(IFFU)
Contact: Wu Jieping Medical Foundation
E-mail:[email protected]
May 2015
15–20: New Orleans (LA), USA
Annual AUA Meeting 2015
Contact:AUA
Phone: +1 410 689 3700
Fax:
+1 410 689 3800
E-mail:[email protected]
Website:www.auanet.org/eforms/planning/
index.cfm
20–22: Madrid, Spain
10th European Congress on Menopause and
Andropause
Contact: EMAS administrative office
Phone: +49 30 24603-0
Fax:
+49 30 24603 310
E-mail:[email protected]
29–30: Riga, Latvia
2nd EAU Baltic meeting
Contact: EAU Regional Office
Phone: +31 26 389 0680
Fax:
+31 26 389 0674
E-mail:[email protected]
70th Annual meeting of the Canadian Urological
Association
Contact: Canadian Urological Association
Phone: +1 514 392 7703
Fax:
+1 514 227 5083
E-mail:[email protected]
Website:www.cua.org/
29 June–3 July: Lyon, France
IUGA-ICS 2015
Contact: ICS Office
Phone: +44 117 944 4881
Fax:
+44 117 944 4882
E-mail:[email protected]
Website:http://www.ics.org/2015
July 2015
5–11: Salzburg, Austria
ESU – Weill Cornell Masterclass in General
urology
Contact:ESU
Augustus 2015
19–23: Cartagena, Columbia
Congreso Curso Internacional de Urologia
Contact: Sociedad Colombiana de Urologia
Phone: +571 218 67 00 / 57 310 322 12 10
Fax:
+571 218 86 95
E-mail:[email protected]
Website: www.scu-congreso.com/www.scu.org.co
October/December 2014
Congress calendar 2014/2015
Worldwide, continually updated urological meeting calendar at
www.uroweb.org
27–29: Zurich, Switzerland
11: Nijmegen, the Netherlands
5-9: Montreal, Canada
4th International Neuro-Urology Meeting
Contact: Swiss Continence Foundation
Phone: +41 44 386 3721
Fax:
+41 44 386 3731
E-mail:[email protected]
Website:www.swisscontinencefoundation.ch
"Personalized Cure and Care in Urology - 50 Years
Academic Urology in Nijmegen"
Contact: Dept. of Urology, Radboud UMC
Phone: +31 6 223 116 30
E-mail:[email protected]
Annual Meeting of the International Continence
Society (ICS)
Contact: ICS Office
Phone: +44 117 944 4881
Fax:
+44 117 944 4882
E-mail:[email protected]
Website:http://www.ics.org/2015
16-18: Bilbao, Spain
September 2015
3-9: Prague, Czech Republic
13th European Urology Residents Education
Programme (EUREP)
Contact:ESU
Phone: +31 26 389 0680 Fax:
+31 26 389 0674
E-mail:[email protected]
Website:www.eurep15.org
3-6: Shanghai, China
Asian Urological Association meeting
Contact: Angie See, Department of Urology
Phone: +65 6 3214693
Fax:
+65 6 2273787
E-mail:[email protected]
[email protected]
Website:http://uaanet.org/
10-12: Alicante, Spain
3rd Meeting of the EAU Section of Urolithiasis (EULIS)
Contact: Congress Consultants B.V.
Phone: +31 26 389 1751
Fax:
+31 26 389 1752
E-mail:[email protected]
12th Meeting of the EAU Robotic Urology Section
(ERUS)
Contact: Congress Consultants B.V.
Phone: +31 26 389 1751
Fax:
+31 26 389 1752
E-mail:[email protected]
Website:www.erus15.org
23-26: Hamburg, Germany
67th Congress of the German Society of Urology (DGU)
Contact:DGU
Phone: +49 211 516 0960
Fax:
+49 211 516 0960
E-mail:[email protected]
Website:www.dgu.de/
October 2015
2-4: Budapest, Hungary
EAU 15th Central European Meeting (CEM)
Contact: Congress Consultants B.V.
Phone: +31 26 389 1751
Fax:
+31 26 389 1752
E-mail:[email protected]
Website:www.cem15.org
15-18: Melbourne, Australia
23: ESU organised course at the time of the
national congress of the Moldavian Urological
Society
Contact:ESU
November 2015
2: Tashkent, Uzbekistan
National Congress of the Scientific Society of
Urologists of Uzbekistan
E-mail:[email protected]
35th Congress of the Société Internationale
d'Urologie (SIU)
Contact: SIU Central Office
Phone: +1 514 875 5665
Fax:
+1 514 875 5665
E-mail:[email protected]
Website:www.siu-urology.org/
2: ESU organised course at the time of the national
congress of the Scientific Society of Urologists of
Uzbekistan
Contact:ESU
november 2015:
22-23: Chisinau, Moldavia
12-15: Barcelona, Spain
National congress of the Moldavian Urological
Society
Contact: Prof. V. Ghicavîi
Phone: +373 79469515
Fax:
+373 22 733805
E-mail:[email protected]
7th European Multidisciplinary Meeting on
Urological Cancers (EMUC)
Contact: EAU, ESMO and ESTRO
Phone: +31 26 389 0680
Fax:
+31 26 389 0674
E-mail:[email protected]
Website:www.emuc15.org
For more elaborate information on all EAU
meetings please contact Congress
Consultants or consult the EAU website:
Phone: +31 (0)26 389 1751
Fax:
+31 (0)26 389 1752
E-mail:[email protected]
Website:www.uroweb.org
For more elaborate information on all ESU
courses please contact the European School
of Urology or consult the EAU website:
Phone: +31 (0)26 389 0680
Fax:
+31 (0)26 389 0684
E-mail:[email protected]
Website:www.uroweb.org
ERUS2014: Robotic Urology draws big crowd to Amsterdam
Three-day meeting included programme for nurses, young robotic urologists
By Loek Keizer
The YAU - Junior
ERUS Programme
All-day, state-of-the-art live surgery might have
been an important attraction, but it’s certainly not
the only important development that drew over 700
delegates to central Amsterdam for three days.
Educational courses, expert lectures, hands-on
training and new developments in certification of
the field were important topics for the urologists,
nurses and residents that attended the 11th EAU
Robotic Urology Section Meeting on 17-19
September.
ERUS14 featured a special programme for
young urologists and others interested in
getting involved in robotic surgery. Important
topics include the economics of robotic surgery,
a look at the literature, and the importance of a
viable certification programme. Dr. Carl
Wijburg (Arnhem, NL), Session co-chairman:
We spoke to Dr. Henk Van Der Poel (Amsterdam,
NL), Chairman of the local organising committee,
about the scope of the meeting, choices behind the
scientific programme and the specifics of robotic
urology.
“This marks the first year that the ERUS meeting is
completely organised by the EAU. We’ve seen around
700 registrations, which is extremely encouraging. In
terms of what we have to offer, my personal interest is
training.” ERUS14 offered several daily sessions of
hands-on training for novice surgeons and those who
wanted to familiarise themselves with the basics of
robotic surgery. In addition, there was an extensive
“YAU-Jr. ERUS” programme for the beginning robotic
urologist.
Dr. Van Der Poel demonstrating the wide range of optical technologies available for robotic surgeons
Nationwide live surgery
Instead of being confined to Amsterdam, Dr. Van Der
Poel was pleased to highlight the national level of
cooperation that made the live surgery aspect of the
Robotic training
congress possible. While all delegates were gathered
“We’re making strides towards certification for
in the Beurs van Berlage in the Dutch capital, the
robotic surgery. In the Netherlands, people drove cars actual surgery took place in the Maasstad Hospital in
for thirty years before the concept of a “driver’s
Rotterdam. The distance of 70 km between the two
license” based on testing was introduced in the 1920s. locations was a new distance record for live
Of course we don’t want a repeat of that in robotic
transmission at an ERUS meeting. “This is truly a
surgery. We’re developing a certification process and nationwide effort, involving patients from all across
the results of the second, six-month pilot were
the country being referred to Rotterdam to make this
presented at ERUS14. We’re also gaining a lot of data possible. It’s a testament to the efforts of Dr. Sjoerd
and insights from the hands-on training and
Klaver and his team that all national and EU-protocols
simulation programmes that we have. Steps during a were followed to the letter, as well as the EAU’s own
surgical procedure are now analysed individually,
Policy on Live Surgery.”
helping pinpoint where improvement of the individual
surgeon is needed.”
More and more urological events are following the
EAU’s policy, which puts patient concerns first. “The
“Rather than wait for laws to come into practice, we
EAU can be commended for facing up to concerns
are already gaining insights so that we can advise
about live surgery. Session chairs are required to
cut-off points for robotic competence. The EAU helps
interrupt the two-way broadcast if he or she feels the
by supporting this scientific side of the debate:
surgeon is distracted. There is also an independent
publications, gathering data and strengthening our
doctor, a patient advocate closely monitoring
case in that regard.”
proceedings to ensure that the patient is getting the
best possible care.”
October/December 2014
While live surgery is an important draw, Dr. Van Der
Poel emphasises that presentations based on
pre-recorded footage are valuable as well. “It can be
an advantage to pause the footage, and to know how
the procedure ends. At the next ERUS meeting, we
will present the follow-up for the patients operated in
Rotterdam, but with pre-recorded cases, we of course
already have this information.”
Optics in robotic surgery
Having performed a sentinel lymph node and
extended radical prostatectomy the afternoon before,
Dr. Van Der Poel explains the unusual colours that the
audience was treated to during the procedure. “We
used both Storz FI near-infrared and Intuitive Firefly
to highlight different optical techniques that are
available to surgeons. We use tracers that do not
show up in natural white light, preserving the normal
view for the surgeon. By using special wavelengths of
light, we can reveal much more information than is
available to the naked eye.”
During the procedure, which involved fluorescent and
radiological tracer injection into the prostate to reveal
the nodes, the audience followed along, with different
filters and views showing different parts of the
“The programme was especially geared to
young urologists who are interested in starting
with robotic surgery, so we try to keep it
approachable.” Dr. Wijburg also spoke at the
session, looking at the total costs and benefits
for institutions who are considering the
purchase of a surgical robot. One big
advantage of the robot is that patients spend
less time recuperating and have a shorter
hospital stay. The high purchase price of the
robot can already be recouped within several
years.
“Besides costs, we are more interested in the
quality of care, so we also had an excellent
session that looked at the best articles about
outcomes of robotic surgery. What can we say
about complications and the learning curve?
We need standardised reports of complications
to compare outcomes. The learning curve is
probably never ending, because robotic
urology is a fast-evolving field.”
anatomy. “There aren’t any standards yet, using
different tracers will allow tissue labelling in the
future. I would expect that in ten years’ time,
everyone will have implemented imaging modalities
that provide detailed information on tissue properties
e.g. cancer location. What we demonstrated yesterday
was truly cutting-edge but only the beginning of
image guided surgery.”
For more information about the Nurses’ Programme
at ERUS14, please turn to page 38. For a complete
impression of ERUS14, including photo albums,
interviews and abstracts, please visit erus2014.
uroweb.org
European Urology Today
37
Nurses’ Programme at EAU Robotics Section Meeting
Shifting roles for nurses and the importance of certification
By Loek Keizer
the nurses did take the initiative as well. When ERUS
was founded, there was a simultaneous desire to
Uniquely for a Section Meeting, the ERUS Meeting in involve nurses in the emerging field of robotic
Amsterdam featured a full-day programme for nurses urology. The whole team, from surgeons to nurses,
involved or interested in robotic surgery. With ERUS
should be certified and trained for robotic urology.”
coming under the wings of the EAU, the EAUN is now
cooperating with the ERUS nurses' group. Special
De Blok on the roles of nurses in the OR: “There are
topics were covered, with opportunities for
some international differences, which become
knowledge exchange and hands-on training.
apparent at meetings like this. In some countries, the
nurse is a surgeon’s first assistant whereas in others
Mr. Willem De Blok, clinical nurse specialist in
one urologist is required to assist another.
Amsterdam and local organiser for the EAUN
Programme in Amsterdam on September 17th spoke
“In some countries nurses or OR assistants have a
to us looking back on the successful day. The EAU
larger role to play, taking care of routine procedures
Robotic Urology Section Meeting is the only
so that the surgeon can focus on patients that do
specialised meeting with its own nurses programme: require specialist care. In the UK, there is a similar
“I think ERUS can be commended for this, although
division of labour although it’s not formally arranged
this way like in the United States or Canada, which
pioneered the concept of the nurse practitioner.”
European Association of Urology Nurses
The day’s programme ended with a frank discussion
with a patient who suffered some complications after
Apply for your EAUN
membership online!
Would you like to receive all the benefits of
EAUN membership, but have no time for
tedious paperwork?
Becoming a member is now fast and easy!
www.eaun.uroweb.org
Nurses Söderkvist and Rundin from Stockholm speak on their
hospital’s experiences with performing five prostatectomies in
a single day
The day’s programme attracted 76 nurses (including
faculty) and offered lectures and workshops on a
variety of topics including cost-efficiency throughout
robotic procedures, a case of five prostatectomies in
one day, and state-of-the-art overview lectures from
urologists. Break-out sessions allowed ward and OR
nurses to attend a special scientific programme, as
well as an opportunity for hands-on training. “The
hands-on training was popular and well-received. We
would have dearly liked to have given more nurses
the opportunity to take part in hands-on training, but
we were limited by the number of machines
available.”
Go to www.eaun.uroweb.org and click EAUN
membership to apply online. It will only take
you a couple of minutes to submit your
application, the rest - is for you to enjoy!
relationship as a result of the procedure. As nurses,
we of course deal with the patient on a different level
from the surgeons. It’s important that we keep this
human element in mind at meetings like these.”
EAUN Board
The nurses' day at ERUS attracted nurses from 10 European
countries, South Korea and the USA
a robotic prostatectomy. Involving a patient gave the
attending nurses a good indication of how a patient
experiences the whole procedure, and also allowed
them to ask questions that one would not necessarily
ask one’s own patients as they are treated. De Blok:
“The patient was very open to talk about issues like
incontinence and impotence, including the end of his
Chair
Chair Elect
Past Chair
Board member
Board member
Board member
Board member
Board member
Board member
Lawrence DrudgeCoates (UK)
Stefano Terzoni (IT)
Kate Fitzpatrick (IE)
Paula Allchorne (UK)
Simon Borg (MT)
Willem De Blok (NL)
Erica Grainger (DK)
Susanne Vahr (DK)
Giulia Villa (IT)
www.eaun.uroweb.org
Urinary Tract Infections
1st Course of the European School
of Urology Nursing (ESUN)
8-9 May 2015, Amsterdam, the Netherlands
Includes risk factors for UTI, treatment and prevention, health care worker
and patient education and development of a prevention plan for your own clinic 9 modules – expert faculty – concluded with test
Full programme and application form can be requested at [email protected]
Registration fee 100€ (flight and 1 hotel night are covered by EAUN)
Application deadline: 20 December 2014
Supported with an educational grant from Wellspect
Fellowship Programme
European
Association
of Urology
Nurses
European
Association
of Urology
European
Nurses
Association
of Urology
Nurses
Call for Papers
The International Journal of
Urological Nursing - The Official
Journal of the BAUN
The International Journal of Urological Nursing
is clinically focused and evidence-based and
welcomes contributions in the following
clinical and nonclinical areas: • General urology
• Clinical audit • Continence care • Clinical
governance • Oncology • Nurse-led services •
Andrology • Reflective analysis • Stoma care •
Education • Paediatric urology • Management •
Men’s health • Research
There are many benefits to publishing in IJUN,
including:
• Broad readership of papers—all published
papers will be available in print and online
to institutional subscribers and all
members of the British Association of
Urological Nurses
• Fast and convenient online submission—
articles can be submitted online at
http://mc.manuscriptcentral.com/ijun
38
European Urology Today
Visit a hospital abroad!
1 or 2 weeks - expenses paid
• Fast turnaround—papers will be reviewed and
published quickly and efficiently by the editorial
team
• Quality feedback from Reviewers and
Editors—double-blind peer review process with
detailed feedback
• Citation tracking—authors can request an alert
whenever their article is cited
• Listed by the Science Citation Index Expanded™
(Thomson ISI)
For further information and
a free sample copy go to:
www.wileyonlinelibrary.com/journal/ijun
Application deadline: 31 January 2015
• Only EAUN members can apply, limited places available
• Host hospitals in Belgium, Denmark, the Netherlands,
Sweden, Switzerland and the United Kingdom
• A great way of widening your horizon
For Fellowship application forms, rules and regulations and information on which specialities
the hosting hospitals can offer please visit the EAUN website.
T +31 (0)26 389 0680 F +31 (0)26 389 0674 [email protected] www.eaun.uroweb.org
European
Association
of Urology
Nurses
October/December 2014
EAUN joins Chinese Urology Association meeting
Education strengthens collaborative work on urological nursing care
Lawrence DrudgeCoates
Clinical Nurse
Specialist, Urooncology
EAUN Chair
London (UK)
[email protected]
eaun.org
My visit to China on invitation by the Chinese
Urology Association's Nursing Committee, started
in Wuhan, capital of Hubei province and the most
populous city (population at 10 million) in Central
China. Wuhan lies in the eastern Jianghan Plain
where the Yangtze and Han Rivers meet.
Accompanied by Mr. Larry Tsang and Gilbert Lui,
Nursing committee members of the Chinese Urology
Association, who were instrumental in organising this
visit, I met with Ms. HE Wei, chair of the Nursing
Committee and Prof. YE Zhang Qun, immediate past
president of the Chinese Urological Association (CUA).
Their department, at the Hospital of Tongji Medical
College of Huazhong University of Science and
Technology, is an extremely busy unit where around
10,000 urology outpatients are attended to every
week.
urology nursing care, areas for educational
collaboration and EAUN membership. Such discussions
proved to be both highly informative and productive.
CUA meeting
It was truly an honour to be the first foreign urology
nurse to attend the CUA Annual Meeting, and my visit
was met with both intrigue and delight as I was
introduced to CUA members
I also renewed old acquaintances from Hong Kong
and again met Prof G. Zhou, urology professor of the
Beijing Hospital of Ministry of Health, who had
completed his PhD work at my institution some 12
years ago. As head of international relations for the
CUA, he interviewed me regarding my visit, which
provided an opportunity to highlight the work of the
EAUN and the benefit of collaboration with CUA
nurses.
presentations focusing on the growing role of
rehabilitation, its impact on traditional postoperative
care, improvements being made in the patient's
postoperative recovery rate and shortened hospital
stay. This was something all too familiar in my own
clinical practice, but nevertheless not with the same
population base.
The visit to China very much highlighted the need and
benefit for collaboration across different urology
nursing organisations and the ensuing challenges.
The EAUN’s mission is not only to support and
encourage the development of urology nursing within
Europe, but also to collaborate with national societies
across the globe in support of the development and
application of high-quality urology nursing practices.
This particular issue was evident in discussions
regarding EAUN clinical guidelines-- with translation
and modification to fit local practices- which will
Ms Xiong Wenting presenting a paper on Clean intermittent
catheterisation and bladder puncture gastrostomy in females
with neurogenic bladder
prove to be a very successful initiative. I therefore look
forward to our continued collaboration. My thanks to
the CUA committee for its hospitality and very warm
welcome.
21st CUA conference, Jinan
The nursing component of the meeting was held in the
Shandong Hall. After a few words of Mandarin (which I
practised many times!), I presented an overview of the
EAUN, including its key clinical guideline
developments, e-learning education and membership
benefits, all of which were positively received.
With translators, language did not prove to be of any
hindrance as we discussed common issues we faced in
Colleagues from Hong Kong inc Chinese Urology Nursing
Committee members. From left: Ms Lo Yi Mei, Ms Yang Jiahui,
Mr Larry Tsang, Mr Gilbert Lui , Ms Sophie Come
European Association of Urology Nurses
Being all too familiar with the EAUN abstract
presentations, it was a real insight for me to hear
some of the work being carried out by urology nurses
in China, which was not different from our own. The
meeting received 738 nursing papers for
consideration which covered key aspects of urological
clinical care, nursing education, scientific
management and innovative research. Only 29 of the
738 were presented at the meeting due to practical
considerations of hosting this event. There were
Members of the CUA nursing committee – Ms HE Wei- Nursing Chair (in blue)
15th Asia-Pacific Prostate Cancer Conference
Meeting presents salient nursing issues in prostate cancer
Tanja Rogers, RN
Counties Manukau
Health
Urology Dept.
Auckland (NZ)
[email protected]
cmdhb.org.nz
I attended the 15th Asia-Pacific Prostate Cancer
Conference 2014 held in Melbourne, Australia from 31
August to 2 September together with around 600
other delegates from around the globe.
The conference is renowned for a comprehensive and
stimulating programme that covers clinical urology,
translational science and nursing and other allied
areas. The nursing and allied health section included
many presentations with topics such as: continence,
active surveillance, hormone therapy, advanced
prostate cancer and current nursing and allied health
research trends. The following is a summary of key
points from three of the sessions I attended.
leakage post-operatively and return earlier to normal
life. She added that one of the main benefits of
teaching PFE pre-operatively is that it is easier to
teach motor control to men who don’t have pain. The
pre-operative PFE education session also provides an
opportunity for health professionals to cover
information that helps establish realistic postoperative goals and expectations. Assessment during
this phase also allows for identification of any
pre-existing voiding patterns that may require
investigation prior to surgery such as detrusor
overactivity.
Neumann also said that teaching PFE needs to be
personalised to suit each individual since not
everyone learns the same way. She believes that the
best way to deliver PFE education is to use a
combination of written and verbal information, as
well as pelvic anatomy models and pictures.
Transperineal ultrasound and digital rectal
Dr. Trish Neumann, specialist continence and pelvic
floor physiotherapist, presented a session entitled
‘Teaching pelvic floor exercises (PFE) to men before
prostate surgery- what is best practice?' According to
Neumann, post-operative PFE training isn’t effective
and that men who are taught PFE prior to prostate
surgery have an earlier return of bladder control, less
European Association of Urology Nurses
October/December 2014
Melbourne was hosting the 15th Asia-Pacific Prostate Cancer
Conference
examination can also be used to assess how well men
are contracting their pelvic floor muscles.
Mr. Jeremy Grummet, a urological surgeon specialised
in urological cancers, gave an overview of
transperineal (TP) and transrectal ultrasound (TRUS)
guided prostate biopsy techniques focussing on the
implications for the patients undergoing the
procedures. Grummet said approximately 50% of
TRUS biopsies are negative for cancer since either the
cancer has been missed by the biopsy sampling
process or because there was no cancer present in the opined that TP biopsy should be offered as an option
prostate gland. He reported that the TRUS biopsy
to all patients in whom a prostate biopsy is indicated.
procedure causes pain and carries a significant risk of
post-procedure infection.
Prof. Daniel Galvao presented a session entitled
‘Active surveillance for prostate cancer- potential
application of exercise medicine’. Galvao has been
"...participants undergoing
involved with numerous trials of the potential benefit
of exercise in men with prostate cancer. He said that
supervised exercise had a more
participants undergoing supervised exercise had a
positive outlook and a stronger
more positive outlook and a stronger sense of social
belonging. They also had fewer symptoms of
sense of social belonging."
depression and fatigue and an improvement in their
quality of life measures. He also underscored the
According to Grummet, one way to address the risks
importance of the role of nurses in educating patients
on how to increase their quality of life. He added that
of TRUS biopsy is to be smarter in the way we use
PSA testing, ensuring it is used in men most likely to
there is a wealth of evidence showing that exercise is
benefit from an early diagnosis of prostate cancer. He safe and well tolerated by prostate cancer patients on
also recommended that men should have an MRI scan active surveillance.
prior to TRUS biopsy to enable a targeted biopsy, thus
decreasing the detection of insignificant low-risk
Overall, I found the conference very interesting with
content that motivates me to pursue ideas that can
cancers. Grummet advocated TP biopsy as a method
of decreasing infection risk and avoiding the use of
lead to improved care of prostate cancer patients. The
broad spectrum prophylactic antibiotics. TP biopsy
next conference in the series is the Prostate Cancer
also enables targeted biopsies and reduces the
World Congress in Cairns, Australia from August 18 to
discomfort associated with prostate biopsy since it is
21, 2015. I hope you can join us for another dynamic
meeting!
performed under general anaesthetic. Grummet
European Urology Today
39
What to expect at the EAUN 2015 Annual Meeting
Madrid programme will feature new topics, current issues and trends
Stefano Terzoni
Chair EAUN Scientific
Congress Office
Milan (IT)
Other items in the programme aim to provide
practical and useful information which can be useful
in our everyday clinical practice, including topics such
as practical management of urological emergencies,
urological care for people with learning disabilities,
ongoing challenges in male sexuality, intravesical
instillation and BCG treatments, 3Tesla magnetic
resonance, and many others.
[email protected]
Workshops and panel discussions
Several workshops will be offered, including a session
on perioperative care in prostate disease, updates on
pelvic floor rehabilitation, an ESU course on female
sexual assessment and rehabilitation (in collaboration
with the European School of Urology), success factors
in self-dilatation, UTI in clean intermittent
catheterisation, troubleshooting in patients with
indwelling catheters, psychological aspects of living
with cancer, and care pathways in bladder cancer
treatment.
More than 300 delegates from 27 countries attended
the 15th EAUN Meeting held in Stockholm last April,
which attracted this year outstanding contributions
by lecturers from all over Europe.
The meeting in 2015, to be held in Madrid from March
20 to 24, promises to be even more interesting: the
EAUN scientific committee and the board took into
consideration the suggestions provided by the
delegates in Stockholm. The most appreciated
sessions will also be in next year’s programme plus
new topics and current issues.
The programme, available on the website www.
eaunmadrid2015.uroweb.org, begins with a plenary
session regarding the future of urological nursing and
the need for a common framework. Currently, there is
an important European debate regarding the
definition (and therefore the future) of urological
nursing. In two years, the European Union is expected
to make a stand on this issue, and this will have an
impact on education, mobility, and working
possibilities for urological nurses across Europe. Thus,
the opening session of the EAUN meeting will focus
on this important topic, with lectures on the various
aspects followed by a panel discussion. We invite you
to join the discussion, as this will have repercussions
on our daily practice.
European Association of Urology Nurses
A new EAUN guideline on intravesical instillation,
developed by the EAUN guidelines panel, will be
presented. The Marketplace Session, already a
well-known and appreciated session in past
meetings, will allow participants to discuss adapted
physical activity, sexual and urological rehabilitation,
and ERAS (Enhanced Recovery After Surgery) with
internationally renowned experts.
As in the previous editions, two poster sessions have
been included in the programme. The number of
abstracts submitted over the years has been
increasing, and many important topics have been
addressed by high quality posters. Everyone eligible
for EAUN membership has the opportunity to submit
their abstract before December 1st via the congress
website.
A video session called “Surgery in Motion,” first
introduced in Milan and greatly appreciated by the
delegates, will be included in the Madrid programme.
Original videos, produced in the operating theatre,
will show and comment on unusual surgical
Panel discussion on the European perspective of urology nursing at the EAUN Meeting in Stockholm last April
situations. Additional expert commentary on these
procedures will be shared with the audience to
provide practical information.
Deadline for submitting, by email, your research
proposal is December 1 (further details on the
website).
The classic Nursing Difficult Case Solution session
entitles free registration for authors of the most
interesting nursing cases. These selected authors will
also present their work during the meeting. We
encourage submissions of original cases by e-mail
(details on the website) before December 1. Those
who submit a case and are not yet EAUN members
will be granted free membership for 12 months.
The 16th EAUN Meeting in Madrid will serve as an
excellent opportunity to share expertise and for both
EAUN members and non-members to be directly
involved in improving urological nursing and play an
active role in discussing current issues. Nursing cases,
posters and research projects are welcome, and
would contribute greatly in an active exchange of
knowledge and information.
Finally, if you have a planned research project, the
EAUN Research Competition is open with a €2,500
prize to be awarded to the most significant research
project, enabling authors to receive support and
funding. The author’s proposed research will be
presented in summary form on the EAUN website.
We look forward to receiving your ideas and
suggestions for discussion topics. For additional
information, visit our website or contact [email protected]
uroweb.org in case of queries.
16th International
Register now for the
early bird fee!
EAUN Meeting
Deadline
12 January 2015
21-23 March 2015, Madrid, Spain
Preliminary Programme
Saturday, 21 March 2015
Sunday, 22 March 2015
Monday, 23 March 2015
09.00 – 10.00
Workshop
Intravesical instillation in NMIBC
09.00 – 10.00
Workshop
Difficult case session
09.00 – 10.00
Workshop
Pelvic floor rehabilitation for LUTS:
What’s new?
10.15 – 10.45
State-of-the-art lecture
PSA, is it a Patient Stress Amplifier?
09.00 – 10.15
Opening Plenary Session
The future of urological nursing The need for a common framework:
time is running out
Inside the body - surgery in motion
(videos)
10.15 – 10.45
State-of-the-art lecture
BCG treatments for superficial
bladder cancer
10.30 – 11.15
Workshop
Nursing challenges in urodynamics
10.15 – 11.15
10.45 – 11.15
10.30 – 11.15
Workshop
Contemporary issues in patient
pathways and cancer treatment
Workshop
Troubleshooting and quality of live
in indwelling catheterisation
State-of-the-art lecture
3Tesla Magnetic Resonance
Imaging for PCa
10.45 – 11.15
10.15 – 12.45
Workshop
Ongoing challenges in health
and sexuality in male patients
State-of-the-art lecture
Not only instillation: BCG perfusion
for kidney and urethra
EAUN-ESU Course - 2
Female sexual assessment and
rehabilitation
11.30 – 12.15
Workshop
Care pathway and rehabilitation in
bladder cancer surgery
13.15 – 13.45
EAUN General Assembly
09.00 – 10.15
11.30 – 12.30
11.30 – 12.30
Nursing Research Competition
12.45 – 13.45
EAUN-EORNA Workshop
Diagnosis and peri-operative care
in prostate disease
14.00 – 14.30
State-of-the-art lecture
Best practice principles in the
urological care for people who
have a learning disability
14.00 – 15.15
Poster Abstract Session
14.45 – 17.00
EAUN-ESU Course - 1
Practical management
of urological
emergencies
11.30 – 13.15
Poster Abstract Session
12.15 – 13.15
Workshop
Living with prostate cancer:
Daily issues and quality of life
14.45 – 16.45
Market Place Session
Rehabilitation in urology cancer care
14.45 – 15.45
Workshop
UTI in clean intermittent
catheterisation: What’s new?
16.00 – 17.00
Workshop
Clean intermittent catheterisation
and self dilatation: quality of life
and success factors
13.45 – 14.00
EAUN Award Session
Supported with an educational
grant from AMGEN
Scientific Committee:
Stefano Terzoni (IT), Chair
Bente Thoft Jensen (DK)
Jerome Marley (GB)
Lisette Van De Bilt (NL)
Rita Willener (CH)
For more information:
[email protected]
#EAUN15
www.eaumadrid2015.org/eaun
40
European Urology Today
See you in Madrid!
in conjunction with
October/December 2014