European Urology Today - Vol. 27 No.4 - August/September 2015

European Urology Today Official newsletter of the European Association of Urology Excellent training and support at AKH Vienna

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Dr. N. Musko

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Vol. 27 No.4 - August/September 2015

A long-term biobank of kidney precursors?

Dr. C. Vera-Donoso

Social media and medicine

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Dr. L. Martinez (photo) & Dr. J. Gómez Rivas

7th EMUC: Identifying gaps in multidisciplinary approaches EMUC offers platform for critical assessment, cancer experts say

By Joel Vega

Urological Imaging (ESUI) holds its fourth meeting with “Imaging and Individualised Medicine” as theme.

With optimal treatments for malignant diseases requiring multidisciplinary approaches, effective collaboration is crucial. In urological malignancies, European cancer experts consider the European Multidisciplinary Meeting on Urological Cancers (EMUC) as the frontline platform to identify prospects and assess standards across various disciplines.

First organised in 2007, and held annually since 2011, the EMUC will hold its seventh edition in Barcelona, Spain from November 12 to 15. In recent years the EMUC has also complemented its Scientific Programme with parallel meetings that examine recent developments and challenges in urology, medical oncology and radiology.

“The European School of Oncology (ESO) will also hold during EMUC15 the ESO Interdisciplinary Conference to examine insights on personalised approach to prostate cancer management,” said the EMUC Scientific Committee. And on the EMUC’s opening day on November 12, the EAU Section of

Courses organised by the European School of Urology (ESU) also complement the Scientific Programme’s focus on the medical treatment of metastatic kidney and castrate resistant metastatic prostate cancer, future prospects and the impact of the latest research outcomes.

The EMUC is annually organised by three lead associations, the European Society for Medical Oncology (ESMO), European SocieTy for Radiotherapy & Oncology (ESTRO) and the European Association of Urology (EAU). (For details on the EMUC’s full Scientific Programme, see Page 27).

“It is necessary to establish a coherent strategy, follow the evidence and consider the experience of other experts which can only raise the level of medical care,” said Prof. Morgan Roupret (FR) who will give an update lecture on BCa treatment strategies.

“EMUC is, in fact, a ‘super multi-disciplinary team,’” added Roupret.

Technology and Urology: A delicate balance Prof. Manfred Wirth Editor-in-Chief Dresden (DE)

Technology, over time, is often relegated to the shadows cast by rapid, evolutionary changes. But we carry on, hopeful that a significant breakthrough is within reach.

Manfred.Wirth@ uniklinikumdresden.de

In this issue of the newsletter, you will find a preview of the 7th European Multidisciplinary Meeting on Urological Cancers (EMUC), an international meeting that highlights the gains and challenges in providing optimal treatment to onco-urology patients. I would encourage our members to attend, or closely follow this important event since it always casts a critical eye on multidisciplinary practices.

The role of medical technology often crops up in the delivery of healthcare, an issue that is as old as medicine itself but still a recurring theme that always has a profound impact on how we deliver- or fail to deliver- optimal treatment.

In plenary discussions, roundtable debates, thematic sessions, courses and poster sessions in our meetings, technology’s crucial role underpins our clinical practices, and the way it often overtakes our clinical management reflects its multi-faceted role— as a driver or catalyst for change on one hand and, on the other, as a cautionary mechanism that prompts us to critically re-assess and take stock of our current achievements.

"Collectively, all these activities speak of our attempts to clarify and examine issues and evaluate our clinical management with the aim to improve on them, if not to discover new ways of treatment."

There are also reports from various meetings, articles on fellowships and other feature news articles submitted by our contributors. Collectively, all these From the search for biomarkers in cancer therapy, the activities speak of our attempts to clarify and examine use of combined and targeted agents to the efficacy of issues and evaluate our clinical management with the diagnostic and imaging techniques, at every turn we aim to improve on them, if not to discover new ways of are confronted with challenges that bring us back to treatment. And besides the regular columns in this the long-standing dilemmas of medical science. edition we also bring reports on educational Solutions that really matter remain elusive, lost in the programmes and collaborative projects with our mysteries of human physiology and disease affiliate partners that inform you of urology trends and characteristics and progression. programmes in the months ahead. By the time you are reading this edition, summer is coming to a close with But regardless of our meagre attempts in medicine, our minds and bodies fully renewed for another season we continue to stake our claim in unknown territories. of challenges in our hospitals, clinics and universities.

We all know that effective medicine is a delicate balance that involves what science and technology can offer, what we are prepared to do for our patients, and the patient’s own hopes and aspirations. Respecting the limits and acknowledging the constraints of this balance may prove to be crucial.

Medical oncologist Maria De Santis (GB) highlighted the role of meetings such as EMUC. “EMUC does not only allow for a high-quality educational meeting in a multidisciplinary setting but also the interaction of disciplines and the participants themselves… In this way we help identify educational gaps, enabling us to address them,” said De Santis.

"It is necessary to establish a coherent strategy, follow the evidence and consider the experience of other experts which can only raise the level of medical care.”

"EMUC does not only allow for a high-quality educational meeting in a multidisciplinary setting but also for interaction of disciplines and the participants themselves…"

In-depth, compact programme Aside from the plenary sessions that will feature focused debates, best of journals, clinical case discussions, state-of-the-art lectures, best of journals, clinical case discussions, best abstracts, and updates on clinical trials, EMUC also enables experts from medical oncology, urology, and radiotherapy to directly confer with their colleagues regarding best practices and new research.

For the second time, EMUC will host the Autumn meeting of the Young Academic Urologists Working Parties. Also in the scientific programme are the ESU-ERUS Hands-on Training courses and Falcon Workshop which aim to refine skills in minimal invasive procedures.

Dr. Thomas Powles (GB), who will speak on systemic treatments in bladder cancer, said bladder cancer research funding needs a boost, compared with other urological malignancies. “Bladder cancer research has been somehow left behind,” said Powles as he noted that immune therapy is a promising new treatment in transitional cell carcinoma (TCC) of the bladder.

All experts agree that with medicine becoming more focused on the patient’s unique disease characteristics, so-called personalised medicine meant the unified efforts of doctors . “Bottom line is I only see positive aspects in multidisciplinary team decisions,” said Roupret.

For news updates and reports during the 7th EMUC, check out the EAU’s web pages at www.uroweb.org and the EMUC’s meeting website at www.emuc15.org

www.eau16.org

Networking at the EMUC 2014 in Lisbon

EMUC Organising Steering Committee ESMO Prof. Cora Sternberg, Rome (IT) ESTRO Prof. Philip Poortmans, Nijmegen (NL) EAU Prof. Hein Van Poppel, Leuven (BE) EMUC Scientific Committee ESMO Dr. Jan Oldenburg, Oslo (NO) ESMO Dr. Thomas Powles, London (GB) ESTRO Dr. Barbara Jereczek-Fossa, Milan (IT) ESTRO Prof. Vincent Khoo, London (GB) EAU Prof. Alberto Briganti, Milan (IT) EAU Prof. George Thalmann, Berne (CH) EORTC GUCG Prof. Bertrand Tombal, Brussels (BE) EUOG Prof. Susanne Osanto, Leiden (NL) ESUR Prof. Gertraud Heinz-Peer, St. Poelten (AT) ESUR Prof. Harriet Thoeny, Bern (CH) ESP/ESUP Prof. Antonio Lopez-Beltran, Lisbon (PT) ESUI Dr. Jochen Walz, Marseille (FR) YAU Dr. Francesco Sanguedolce, London (GB)

#EAU16

Abstract submission closes 1 November

And even the best of technology cannot change that.

August/September 2015

European Urology Today

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BAUS endorses EAU Guidelines British Association joins long list of endorsing national societies

By Loek Keizer The British Association of Urological Surgeons has joined the long list of national societies who officially endorse the EAU’s Guidelines. The cooperation was finalised at BAUS 2015, the Association’s annual meeting, which was held in Manchester on 15-18 June.

“The EAU has a fantastic set of Guidelines, written by expert groups. Without a shadow of a doubt, these are the guidelines we tell our trainees to read,” Mr. Mark Speakman, BAUS President said of the endorsement. “The EAU Guidelines address day-to-day, real-life practice, and they have great breadth in terms of subject matter.”

Mr. Duncan Summerton, BAUS Hon Secretary also emphasised the EAU Guidelines’ “best clinical practice” credentials as a strength. The Guidelines were already commonly used in the United Kingdom, and endorsement largely means formalising this arrangement. BAUS is hoping to write supplementary papers to the Guidelines that will factor in the particularities of the British context.

EAU Guidelines Office Chairman Prof. James N’Dow, hailed the endorsement: “The EAU Guidelines Office is very pleased to have BAUS endorse the EAU Guidelines. British Urologists make up a large proportion of our EAU Guideline Panel membership and the vast majority of British urology residents use the Guidelines throughout their training and for their exit exams; and so this endorsement makes a lot of sense.”

“That said, we could not have achieved this major milestone without the support, leadership and commitment of a number of incredible people including Mr. Speakman, Mr. Summerton, Kieran O’Flynn, EAU Secretary General Chris Chapple and many others.”

European Urology Today Editor-in-Chief Prof. M. Wirth, Dresden (DE)

The EAU Guidelines and BAUS Speakman and Summerton are both clear about the practical value of the EAU Guidelines. However, in a country with a public health system and established guidelines (National Institute for Health and Care Excellence or NICE), some further work is required for a complete endorsement. This would not take the form of adapting or rewriting, but rather providing a supplementary “commentary” on the UK situation.

Speakman: “We are hoping to write some articles to engender enthusiasm among British urologists for using the EAU Guidelines. The articles can compare and contrast, show how they fit into British practice, how we can take them forward.”

Summerton: “the EAU Guidelines represent the best clinical practice. In a public health system such as ours, health economies are also an important factor.

When we publish articles that address the EAU Guidelines for a British crowd, we need to include a nod to health economics, and some other slight differences of the British urological landscape.

Treatment of infertility, for example, differs somewhat from the EAU’s approach. In the UK a lot of infertility practice has gone to gynaecology.”

With regards to the timing of this BAUS-EAU cooperation, both Speakman and Summerton joke about British stubborn insularism. “It would be nice to say that we’re only endorsing these guidelines now because we are thorough! Over time it’s dawned on us that we don’t need to reinvent the wheel. A good group, featuring several prominent British urologists has done the work, analysis and produced outstanding guidelines.”

Mr. Summerton also mentioned the pre-existing NICE guidelines as a contributing factor to a relatively late adoption of the EAU’s Guidelines, citing the need to find a way to combine or ratify the two.

BAUS 2015 The 71st annual scientific meeting of BAUS attracted 1,200 delegates, a figure the organisers were extremely pleased with. Mr. Speakman pointed out an evolution in the scientific programme of the meeting over the past few years, settling on the current four-day arrangement.

The first day was reserved for three simultaneous section meetings, addressing Academic Urology, Andrology and Genito-Urethral Surgery, and Female, Neurological and Urodynamic Urology, respectively.

Other well-attended sessions in the regular scientific programme were the “as live” surgery sessions, and topics like antimicrobial resistance and urinary tract infections drew large crowds.

The scientific programme featured several contributions from EAU Board Members, with Prof.

Hein Van Poppel speaking on hormone-refractory

prostate cancer, and Prof. Francesco Montorsi presenting ten-year follow up on sex and the heart. In addition to chairing a session together with Prof.

Montorsi, Prof. Chapple presented on female mid-urethral tapes, and Prof. James N’Dow spoke on the usage of evidence-based medicine.

While the scientific programme included international speakers, BAUS 2015 was chiefly a British meeting, catering to the UK’s 1000 registered urologists. One session in particular illustrated the unique situation of urologists in the UK and its National Health System.

A session was held about the clinical and commissioning priorities of robotic surgery in the UK.

"When we publish articles that address the EAU Guidelines for a British crowd, we need to include a nod to health economics, and some other slight differences of the British urological landscape."

Mr. Speakman neatly summarises the situation: “Costs of robotic units are high, and implementation has not been systematic, but the result of chief executives pooling money. As it stands, we have 50 units in England, one in Wales, and none in Scotland. The debate then follows whether it’s inefficient to have a concentration of robots in one area, or if it’s better to have specialised centres.”

Collaborating with the EAU On the topic of broader EAU-BAUS collaboration, both BAUS trustees mention the recent change in EAU leadership. Mr. Summerton points to Prof. Chris Chapple, EAU Secretary General since March 2015, as being keen to bring British endorsement to the EAU Guidelines.

Mr. Speakman was complimentary of Prof. Chapple’s predecessor, Prof. Per-Anders Abrahamsson.

“EAU-BAUS cooperation is getting better and better.

Per-Anders did a fantastic job, and he was a true diplomat who travelled the world, meeting other organisations. Chris Chapple was handed a playing field that was sorted out, stable and ready to go forward. I’ve known Chris for 25 years, and it will be a pleasure to keep working with him!”

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. Ploussard, Toulouse (FR) Prof. J. Rassweiler, Heilbronn (DE) Prof. O. Reich, Munich (DE) Dr. F. Sanguedolce, London (GB) Dr. S. Sarikaya, Ankara (TR) Special Guest Editor Mr. J. Catto, Sheffield (GB) Founding Editor Prof. F. Debruyne, Nijmegen (NL) Editorial Team L. Keizer, Arnhem (NL) A. Leon, Arnhem (NL) H. Lurvink, Arnhem (NL) J. Vega, Arnhem (NL)

Membership extends to medical students An interview with the first medical student to join the EAU

By Loek Keizer

EUT Editorial Office PO Box 30016 6803 AA Arnhem The Netherlands T +31 (0)26 389 0680 F +31 (0)26 389 0674 EUT@uroweb.org Disclaimer No part of European Urology Today (EUT) may be reproduced without written permission from the Communication Office of the European Association of Urology (EAU). The comments of the reviewers are their own and not necessarily endorsed by the EAU or the Editorial Board. The EAU does not accept liability for the consequences of inaccurate statements or data. Despite of utmost care the EAU and their Communication Office cannot accept responsibility for errors or omissions.

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European Urology Today

The European Association of Urology recently introduced a new form of membership, targeting medical students who are specialising in urology.

The Association welcomes its first medical student, Mr. Oliver Brunckhorst, who is based in London.

Medical students can now join residents, urologists and retired urologists in membership, receiving many of the same benefits. This includes access to the online EAU Guidelines, free access to the Annual EAU Congress, and online access to the journal European Urology. A student membership costs €50 annually.

Mr. Brunckhorst is a final-year student at Imperial College, developing an interest in urology: “I have always had a keen interest for surgery and this has only strengthened as I progress through my training.

However, more recently I have gained more exposure to Urology and have become extremely intrigued by this field, particularly with the large variety offered in every day practice and the very effective use of technology within the specialty.”

As for many non-members, the Annual EAU Congress was a big draw for Brunckhorst to consider membership. “Through my interest in Urology I came to be aware of the EAU and its role in the field.

However, I came to join the organisation when I was looking to present some of the work I had undertaken within Urology during my Intercalated Bachelor degree.”

“I was well aware that one of the highlights of the calendar was the Annual EAU Congress, but as a student I would have been unable to afford the full fees of the conference. Therefore, I enquired about membership and therefore was very grateful to be able to attend to present my work through this.”

Membership Benefits The EAU Membership Office decided to open membership to medical students to attract members and affiliate them with the Association at an earlier point in their career. Student membership will be adjusted to resident membership and full membership as the member progresses through his or her career.

Student membership offers many of the same benefits as a resident’s or full membership, including but not limited to: online access to the EAU Guidelines; a hard copy of the Pocket Guidelines; online access to Oliver Brunckhorst, European Urology and EU Focus; advanced access to UROsource; London (UK) free access to the Annual EAU Congress and discounts for other events; and access to a variety of publications. For a full list of benefits and more information on signing up, please visit the EAU’s membership pages!

Mr. Brunckhorst thinks he will benefit from his membership, even as he prepares for his final exams: “I think the main things this will enable me to achieve is keep up to date with the field of urology, and, as mentioned, give me the opportunity to attend events.

Additionally, some of the resources available on Uroweb such as the EAU Guidelines look to be very useful for my education, even at this stage as I prepare for my finals!”

August/September 2015

Update from the Guidelines Office Systematic reviews and the GO’s summer meetings The Guideline Office (GO) and its panel members continue to work on refining its tasks and activities including systematic reviews and standardisation of word choice in recommendations. Below are some of the most recent GO highlights:

Summer Panel meetings It is a busy time for Guideline Panel meetings with the Panels formalising their text for the 2016 version in time for the October deadline which is fast approaching.

Rephrasing of guideline recommendations A key aim for the Guidelines Panels for the 2016 version will be to standardise how their guideline recommendations are phrased. This was discussed with the Guideline Panel Chairs at the meeting in June and their feedback taken on-board. The Methods Committee have now provided a template to assist the Panels in phrasing their text. For each Guideline section, based on a specific PICO (population, intervention, comparison, outcome) question, there will be:

In June the Urinary Incontinence Panel met in Bern, Switzerland. The meeting, chaired by Prof. Fiona Burkhard, was attended by eight panel members and associates. The key aims of the meeting were to discuss the progress on literature searches and text updates for the 2016 version, planned publications from the panel, and to outline the systematic review priority list for the 2016, 2017 and 2018 editions.

At the meeting, Dr. Arjun Nambiar presented an overview on conducting systematic reviews to address the new methodology set by the Methods Committee (see Photo 3).

• Text body: To include key scientific literature • Summary of evidence: E.g. strength of the evidence, patient values/preferences, knowledge gaps, uncertainties in the evidence • Recommendations: Specific statements, linked to the summary of evidence, which are actionable.

Each recommendation will have a strength rating (strong, moderate or weak).

Recent systematic reviews from the Guidelines Panels Neuro-Urology Panel: The Panel recently had their review ‘Tibial nerve stimulation for treating neurogenic lower urinary tract dysfunction: a systematic review’, published in European Urology.

The Panel systematically reviewed all available evidence on the efficacy and safety of tibial nerve stimulation for treating neurogenic lower urinary tract dysfunction. Early data suggest tibial nerve stimulation might be effective and safe for treating neurogenic lower urinary tract dysfunction, but more reliable evidence is required (see Photo 1 for further information).

Photo 3: Dr. Arjun Nambiar presenting on systematic reviews to the Urinary Incontinence Panel

Also meeting over the summer months were the Muscle Invasive Bladder Cancer (MIBC) Panel in Barcelona (see Photo 4), Paediatric Urology Panel in Istanbul (see Photo 5) and Prostate Cancer Panel in Amsterdam (see Photo 6).

The Prostate Cancer Guidelines Panel met last August 1 to discuss their updating activities for the 2016

#eauguidelines Dissemination of the Guidelines on Twitter For six months the Guidelines Panels have been using Twitter to disseminate their Guidelines in <140 character format using the #eauguidelines. In this short period, just from Guideline Panel tweets alone, the following statistics have been recorded: • Total number of impressions = 146,858 • Sum of engagements = 3,386 • Sum of retweets = 705 To date, the three most popular tweets in terms of impressions, engagements and retweets have been from the Male Sexual Dysfunction, Renal Cell Cancer and Prostate Cancer Guidelines Panels (see Photo 2).

The Dissemination Committee, led by Prof. Maria Ribal, is excited about developing this project further over the coming months.

Photo 4: MIBC Panel meeting to discuss the 2016 Guidelines version, chaired by Prof. Fred Witjes

Help urologists collect CME credits and register your activity today!

(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.

Photo 2: The top 3 most popular tweets from @Uroweb since the launch of #eauguidelines on Twitter.

Guidelines Office

August/September 2015

prints. One of the challenging areas in prostate cancer care is the relevance and timing of treating patients with biochemical recurrence following curative treatment for PCa. The panel should like to systematically assess whether in this setting any PSA rise will need to trigger immediate treatment.

The assumption is that this will not necessarily be true for all sub-groups of patients. However, whether the available data will allow for meaningful conclusions remains to be seen.

The Paediatric Urology Guidelines Panel organised a most successful and enjoyable meeting in Istanbul last July. The panel aim to, stepwise, continue updating their guidelines document and also incorporate the findings of systematic reviews which are now being carried out. For this guideline in particular, which not only covers such a wide range of sub-topics, the task is particularly challenging due to the paucity of high-level data.

Photo 1: The Neuro-Urology Panel review: ‘Tibial nerve stimulation for treating neurogenic lower urinary tract dysfunction: a systematic review’, published in European Urology.

Photo 5: Paediatric Urology Panel meeting to discuss the 2016 Guidelines version, chaired by Prof. Serdar Tekgül

www.eu-acme.org

7th EMUC: Identifying gaps in multidisciplinary approaches . . . . . . . . . . . . . . . . . 1 Technology and Urology: A delicate balance. . 1 Photo 6: Prostate Cancer Panel meeting to discuss the 2016 Guidelines version, chaired by Prof. Nicolas Mottet

BAUS endorses EAU Guidelines . . . . . . . . . . . 2 Membership extends to medical students. . . . 2

A number of other systematic reviews (SRs), the results of which should be included in the next publication, are well underway: • The value of pre-biopsy mpMRI in predicting negative systematic prostate biopsy and the positive predictive value of pre-biopsy mpMRI in predicting positive targeted or systemic prostate biopsy (involving Dr. L. Marconi, Dr. P. Moldovan & Dr. Th. Van Den Broeck); • Antibiotic prophylaxis for prostate biopsies: Risk factors for infection – in collaboration with the Urological Infections Guidelines Panel led by Dr. F. Hofmann, Dr. W. Everaerts & Dr. N. Van Casteren; • How do extended, limited and no LND in radical prostatectomy compare with each other in terms of outcomes? (involving Dr. Th. Van Den Broeck, Dr. N. Fossati & Dr. P-P. Willemse).

All data work for the SR on “The role of androgen deprivation therapy in prostate cancer patients with non-metastatic disease recurrence after local curative treatment” has been completed and a final document should become available shortly. This review was carried out by Dr. R. Van Den Bergh, Dr. N. Van Casteren and Dr. Th. Van Den Broeck.

Have you moved?

Changed name?

New employer?

Alter your personal data on-line: fast and easy www.eu.acme.org

Update from the Guidelines Office . . . . . . . . . 3 Who is who in the EAU. . . . . . . . . . . . . . . . . . 4 ESFFU: Road to the future of female SUI surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Clinical challenge. . . . . . . . . . . . . . . . . . . . . . 7 EAU Research Foundation offer . . . . . . . . . . . 8 Russian urologist still going strong at 85. . . . 8 EUSP Scholarship Report Vienna . . . . . . . . . . 8 EAU-RF launches PRECISION Trial. . . . . . . . . . 9 Advances in laparoscopy for urological indications - Part 1. . . . . . . . . . . . . . . . . . . . . 11 Key articles from international medical journals. . . . . . . . . . . . . . . . . . . . . . . . . . 12-15 Ten questions: Shahrokh Shariat. . . . . . . . . . 15 ESTU: A long-term biobank of kidney precursors . . . . . . . . . . . . . . . . . . . . . . . . . . 16 New continence centre and urodynamic lab in Budapest . . . . . . . . . . . . . . . . . . . . . . 16 ESU section: ESU participates in HUA’s Biennial Scientific Meeting. . . . . . . . . . . . . . . . . . . . . 17 ESU Course in Ukraine . . . . . . . . . . . . . . . . . 17 ESU-Weill Cornell Masterclass 2015 . . . . . . . 18 A memorable training in Salzburg . . . . . . . . 18 Initiatives amid challenges in functional urology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 High scores for Salzburg. . . . . . . . . . . . . . . . 19 E-BLUS looks beyond Europe in 2015. . . . . . 20 YUO section: Paediatric urology training in Istanbul . . . . .

80th Congress of the Spanish Urological Association. . . . . . . . . . . . . . . . . . . . . . . . . .

Activities ESRU Turkey, September 2015 . . . .

ESRU.be Day. . . . . . . . . . . . . . . . . . . . . . . . .

Social media and medicine. . . . . . . . . . . . . .

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ESUT: World Congress of Endourology and SWL. . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 EAUN section: EAUN Conference Scholarship Awards. . . . . 31 “By Nurses, for Nurses”. . . . . . . . . . . . . . . . 32

European Urology Today

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Who is who in the EAU EAU Offices EAU Executive

C. Chapple Sheffield (GB) Secretary General

F. Montorsi Milan (IT) Adjunct Secretary-General & Executive Member Science

H. Van Poppel Leuven (BE) Adjunct Secretary-General & Executive Member Education

M. Wirth Dresden (DE) Treasurer & Executive Member Communication

EAU Board

Office EAU Scientific Congress Office EAU Education Office (ESU) EAU EUSP Office EU-ACME Office EAU Section Office EAU Regional Office

Office Chairman A. Stenzl, Tübingen (DE) J. Palou, Barcelona (ES) V. Mirone, Naples (IT) R. Nijman, Groningen (NL) L. Martínez Piñeiro, Madrid (ES) B. Djavan, Vienna (AT)

Office EAU History Office EAU Strategy Planning Office EAU International Relations Office EAU Membership Office EAU Guidelines Office EAU Young Urologists Office

Office Chairman D. Schultheiss, Giessen (DE) D. Jacqmin, Strasbourg (FR) C. Chapple, Sheffield (GB) I. Korneyev, St. Petersburg (RU) J. N’Dow, Aberdeen (GB) M. Sedelaar, Nijmegen (NL)

EAU Offices

Offices related to Governance

Offices related to Science

Offices related to Education

Offices related to Communication

Strategy Planning Office Chairman: D. Jacqmin, Strasbourg (FR) Member: S. Buntrock, Bad Wildungen (DE) Member: H. Hashim, Bristol (GB) Member: B. Malavaud, Toulouse (FR) Member: C. Surcel, Bucharest (RO) Ex-Officio: C. Chapple, Sheffield (GB)

Scientific Congress Office

Education Office Chairman: J. Palou, Barcelona (ES) Member: M. Babjuk, Prague (CZ) Member: M. Drake, Bristol (GB) Member: M. Kuczyk, Hanover (DE) Member: E. Liatsikos, Patras (GR) Member: O. Traxer, Paris (FR) Member: B. Van Cleynenbreugel, Leuven (BE) Member: H. Van Der Poel, Amsterdam (NL) Member: R. Van Moorselaar, Amsterdam (NL) Ex-Officio: L. Martínez Piñeiro, Madrid (ES) Ex-Officio: H. Van Poppel, Leuven (BE) Consultant: D. Pushkar, Moscow (RU)

History Office Chairman: D. Schultheiss, Giessen (DE) Member: C. Alamanis, Athens (GR) Member: J. Elo, Helsinki (FI) Member: R. Engel, Linthicum (US) Member: L. Fariña-Pérez, Madrid (ES) Member: J. Felderhof, Hoofddorp (NL) Member: P. Figdor, Vienna (AT) Member: A. Figueiredo, Coimbra (PT) Member: A. Jardin, Paris (FR) Member: S. Musitelli, Pavia (IT) Member: P. Rathert, Düren (DE) Member: I. Romics, Budapest (HU) Member: M. Skopec, Vienna (AT) Member: R. Sosnowski, Warsaw (PL) Member: P. Thompson, Kent (GB) Member: P. Van Kerrebroeck, Maastricht (NL) Member: A. Verit, Istanbul (TR) Ex-Officio: M. Wirth, Dresden (DE)

International Relations Office Chairman: C. Chapple, Sheffield (GB) Consultant: D. Castro Diaz, Tenerife (ES) Consultant: F. Cruz, Porto (PT) Consultant: P. Coloby, Cergy Pontoise (FR) Consultant: J. Thüroff, Mainz (DE) Ex-Officio: B. Djavan, Vienna (AT) Ex-Officio: F. Montorsi, Milan (IT) Ex-Officio: H. Van Poppel, Leuven (BE) Ex-Officio: M. Wirth, Dresden (DE)

Membership Office Chairman: I. Korneyev, St. Petersburg (RU)

Search & Nomination Committee 2015-2016 Chairman: C. Chapple, Sheffield (GB) Member: F. Montorsi, Milan (IT) Member: M. Wirth, Dresden (DE) Member: V. Mirone, Naples (IT) Member: J. Palou, Barcelona (ES) Member: F. Debruyne, Arnhem (NL)

Scientific Congress Committee Chairman: A. Stenzl, Tübingen (DE) Member: P. Albers, Dusseldorf (DE) Member: A. Alcaraz, Barcelona (ES) Member: C. Bangma, Rotterdam (NL) Member: A. Briganti, Milan (IT) Member: F. Burkhard, Berne (CH) Member: Z. Culig, Innsbruck (AT) Member: A. De La Taille, Creteil (FR) Member: D. De Ridder, Leuven (BE) Member: W. Feitz, Nijmegen (NL) Member: M-O. Grimm, Jena (DK) Member: T. O’Brien, London (GB) Member: P. Radziszewski, Warsaw (PL) Member: M. Roupret, Paris (FR) Member: J. Sønksen, Herlev (DK) Member: B. Tombal, Brussels (BE) Consultant: M. De Santis, Vienna (AT) Consultant: T. Knoll, Sindelfingen (DE) Ex-Officio: J. Catto, Sheffield (GB) Ex-Officio: C. Chapple, Sheffield (GB) Ex-Officio: B. Djavan, Vienna (AT) Ex-Officio: L. Martínez Piñeiro, Madrid (ES) Ex-Officio: F. Montorsi, Milan (IT) Ex-Officio: J. N’Dow, Aberdeen (GB) Ex-Officio: J. Palou, Barcelona (ES) Ex-Officio: H. Van Poppel, Leuven (BE) Ex-Officio: M. Wirth, Dresden (DE) Video Congress Committee Chairman: A. Messas, Nanterre (FR) Member: A. Carbone, Latina (IT) Member: F. Gómez Veiga, Salamanca (ES) Member: J. Klein, Heilbronn (DE) Member: F. Van Der Aa, Leuven (BE)

Section Office Chairman: L. Martínez Piñeiro, Madrid (ES) ERUS: A. Mottrie, Aalst (BE) ESAU: W. Weidner, Giessen (DE) ESFFU: J. Heesakkers, Nijmegen (NL) ESGURS: R. Djinovic, Belgrade (RS) ESIU: T-E. Bjerklund Johansen, Oslo (NO) ESOU: M. Brausi, Modena (IT) ESTU: A. Figueiredo, Coimbra (PT) ESUI: J. Walz, Marseille (FR) ESUP: A. Lopez-Beltran, Cordoba (ES) ESUR: K. Junker, Domburg (DE) ESUT: J. Rassweiler, Heilbronn (DE) EULIS: K. Sarica, Istanbul (TR) Ex-Officio: F. Montorsi, Milan (IT)

Regional Office Chairman: B. Djavan, Vienna (AT) Ex-Officio: C. Chapple, Sheffield (GB) Ex-Officio: F. Montorsi, Milan (IT)

EUSP Office Chairman: V. Mirone, Naples (IT) Member: T. Borkowski, Warsaw (PL) Member: M. Burchardt, Greifswald (DE) Member: S. Larré, Reims (FR ) Member: M. Ribal Caparros, Barcelona (ES) Member: J. Witjes, Nijmegen (NL) Ex-Officio: L. Martínez Piñeiro, Madrid (ES) Ex-Officio: G. Patruno, Rome (IT) Ex-Officio: J. Schalken, Nijmegen (NL) Ex-Officio: H. Van Poppel, Leuven (BE)

Guidelines Office Chairman: J. N’Dow, Aberdeen (GB) Vice-Chairman: J. Irani, Poitiers (FR) Member: M. De Santis, Vienna (AT) Member: T. Knoll, Sindelfingen (DE) Member: C. Llorente, Madrid (ES) Member: R. Sylvester, Brussels (BE) Ex-Officio: T. Loch, Flensburg (DE) Ex-Officio: H. Van Poppel, Leuven (BE)

EU-ACME Office Chairman: R. Nijman, Groningen (NL) Representative EAU: P. Nyirády, Budapest (HU) Representative EAU: J. Palou, Barcelona (ES) Representative EAU: H. Van Poppel, Leuven (BE) Representative EBU: M. Aitchison, London (GB) Representative EBU: A. Figueiredo, Coimbra (PT) Representative EBU: S. Müller, Bonn (DE)

Young Urologists Office Chairman: Chair French Resident Organisation: Chair German Resident Association: Chair Italian Resident Organisation: Chair Spanish Resident Organisation: Chair Turkish Resident Organisation: Chair UK Resident Association: Chair Residents Working Group Spain: Chair ESRU: Past ESRU Chair: Chair YAU: Member: Member: Ex-Officio: Ex-Officio:

M. Sedelaar, Nijmegen (NL) unknown H. Borgmann, Frankfurt (DE) F. Esperto, Rome (IT) A. Melnick, Barcelona (ES) S. Sarikaya, Ankara (TR) C. Blick, Oxford (GB) J. Gómez Rivas, Madrid (ES) G. Patruno, Rome (IT) J. Vasquez, Frederiksberg (DK) F. Sanguedolce, London (GB) L. Martinez Bustamente, Koper (SL) M. Silay, Istanbul (TR) S. Larré, Reims (FR) H. Van Poppel, Leuven (BE)

Update April 2015

4

European Urology Today

August/September 2015

The making of EAU16

Surgeries organised by the EAU Section of Uro-Technology and their partners. Each surgery must pass ethics rules, fulfil patient’s consent and equipped with all the requisite high-end technology such as robots and the newest lasers.

Highly-qualified, expert surgical personnel are recruited and they prepare many months ahead for specialised procedures.

Timing and logistics: The Annual Congress in figures It may not be obvious but preparing for the EAU Annual Congress takes years and the run-up to the actual congress days involves a complex process that demands not only precision logistics but also creative problem-solving.

Some random facts. In terms of workforce, a typical annual congress will draw on the combined efforts of 119 technicians, 131 meeting hosts and hostesses, 76 EAU staffmembers, 623 faculty members, 340 abstract reviewers and around 140 media representatives.

Logistics are equally daunting. For a meeting with more than 13,000 participants the following are used, transported and installed: 109 computers and laptops, 8,195 square-metre of carpetting, 28,656 meters of electrical cables, nearly 7,000 chairs, 123 mobile phones, 43 printers, 50 walky-talkies and at least 350 Wemicrophones Do in more than 25 meeting rooms. Some

5 Congress Days

11,000+

1065 Abstracts

125+

260+ sessions

Participants Countries

in

2015

Live Stream + Webcasts

of the hardware are directly transported by seven trucks from the EAU Central Office in Arnhem (NL).

Planning for and choosing the final meeting venue requires intricate negotiations that may take place over years. Once a venue is confirmed, at least 10,000 hotel rooms are blocked to ensure easy travel distance to the congress venue. Natural calamities such as the 2010 volcanic eruption in Iceland during the 25th Annual Congress in Barcelona have not only posed challenges, but also provided opportunities. We responded with off-the-road solutions such as presentations via Skype and a continuous on-line feed for real-time viewing.

The Scientific Programme is a complex task with around 269 scientific sessions, organised in four Plenary Sessions, 19 Thematic Sessions, 45 ESU Courses, 37 Hands-on-Training Sessions and around 20 Industry Sessions. For the abstract presentations, there are 100 sessions for Abstracts, 90 for Poster and 10 Video sessions. Around 2,400 lectures and presentations would take place in a span of five days.

In EAU15 we tallied 1,065 abstract presenters and 3,166 registrations for the ESU Courses.

Timing and precision coordination are also constant demands for day-long events such as the Live

Big and small numbers. High precision in exchange for zero-problem incidents.

More important, we’re grateful to everyone who contributes to a successful meeting.

See you in Munich!

Important dates

If clockwork timing is essential before the opening day, it’s highly demanded during the event itself.

A Internet malfunction or a glitch in a PowerPoint presentation can mar an otherwise problem-free session. Even a scratchy sound or high-pitched microphone volume can irritate the most placid audience.

Congress dates 11-15 March 2016 Exhibition dates 12-14 March 2016 Registration open 1 October 2015

All these are done for only the Scientific Programme as we also have the Technical Exhibit that counts more than 2,300 exhibitors and industry representatives. The exhibit is by itself another feat of logistics. One can say staging a wrinkle-free event that involves the participation of hundreds and the attendance of thousands is similar to juggling more than a dozen balls up in the air.

So the next time you sip a cup of coffee during a break, that cup could be one of 11,000 coffee served or consumed that day, most pages in the newsletter you’re reading were prepared at least five months in advance, and the assorted brochures in 12,500 congress bags were carefully collated and inserted by at least 48 pairs of hands.

Abstract submission deadline 1 November 2015 Award submission deadline 1 November 2015 Early fee registration deadline 15 January 2016 Late fee registration deadline 9 February 2016

Check out the programme ove

rview at

www.eau16.org

Sharing Knowledge with the International Community

Submitting an abstract?

Practical Do’s & Don’ts The Annual EAU Congress annually attracts more than 4,000 abstract submissions from urologists and other medical professionals around the world. Competition is tough and 28% is selected.

Here are some handy and practical tips on how your abstract can get the attention it deserves: • • • • • • •

Deliver a clean, precisely worded text free from grammatical and spelling errors. Avoid vague descriptions. Reviewers are less impressed when language is cluttered with unnecessary details; Only use the most relevant illustrations and images in high resolution. There’s nothing more irritating than fuzzy photos and poorly executed graphics; Carefully phrase your concluding statements and emphasise the significance of your study.

Concise statements make an impact; Adopt a neutral tone and avoid writing in argumentative terms which may convey the wrong impression; Thoroughly re-check the facts and proof-read several times; Ask a colleague or mentor for a final review or second reading. Small errors in factual detail may escape your attention; and Submit well ahead of the deadline! Don’t wait for the last hour.

These are only a few suggestions. There are many other handy tips (See EAU Munich Congress Website). The main thing is to deliver original and innovative work, with quality research methodology and data that present the results in precise language.

Good luck to all participants!

Scientific Programme: Examining key issues and trends To fulfill its aim to present a comprehensive Scientific Programme, organisers and the Scientific Office have invited distinguished and expert speakers from around the world to examine key and controversial issues in urology and the prospects that will shape current management strategies.

Recognising excellence EAU Awards highlight innovative, pioneering work Every year during the Annual Congress, the EAU highlights the achievements of innovative and pioneerning work by veteran, mid-career or young urologists across Europe. Aside from a formal ceremony during the opening day where the honours are granted, award winners are also featured in the EAU’s various publications and at the EAU Award Gallery featured during the congress.

unrestricted educational grant of € 5,000 from Karl Storz GMBH & CO.KG.

EAU Prostate Cancer Research Award High-quality research in prostate cancer is one of the EAU’s top research priorities, and to reach this goal the EAU has created the EAU Prostate Cancer Research Award. Supported by an unrestricted educational grant of € 5,000 from the Fritz H. Below is a list and description of the open nomination Schröder Foundation, an expert jury selects the best awards: paper focusing on clinical or experimental studies in prostate cancer. The nominated work must be EAU Best Papers published in Urological Literature published in or accepted by a renowned international EAU Prostate Cancer Research Award 2016 EAU Crystal Matula Award 2016 Awards scientific journal.

For the Best Paper on Clinical or Experimental For a young promising urologist under the age To inspire young and promising reseearchers and Prostate Cancer Research. The paper of 40 who has the potential to become one urologists to pursue innovative studies and reasearch, EAU Crystal Matula Award must have been published or accepted for of the future leaders in academic European there are two EAU Prizes for Best Paper published in For young mid-career urologists, the EAU Crystal publication in a high-ranking international urology. National Societies can nominate a Urological Literature. Aside from the cash prize, the Matula Award is one of the most prestigious honors journal between 1 July 2014 and 30 June 2015. candidate for this award or eligible candidates recognition from the international urological given to a young promising European urologist under can apply by contacting their national community can serve as a boost for scientists to the age of 40. The winner is considered as having the EAU Best Paper Awards 2016 urological society directly. continue their work and expand their professional potential to become one of the future leaders in For the two Best Papers published in Urological networks. Two awards of € 5,000 each will be academic European urology. Other selection criteria Literature on Clinical and Fundamental EAU Hans Marberger Award 2016 granted to the winning authors of the two Best Papers include consistent quality academic work and a Research. These papers must have been published in Urological Literature on Clinical and proven network in clinical research. Laborie supports Fundamental Research. the EAU Crystal Matula Award with an unrestricted educational grant of € 10,000. National societies can EAU Hans Marberger Award nominate a potential awardee, but eligible candidates The EAU Hans Marberger Award is given to the author can also apply for this award through their national of the best European paper published on Minimally urological societies.

Invasive Surgery in Urology. Annually given since 2004, the award is named after Prof. Hans Marberger How to apply in recognition of his pioneering achievements and You can apply for the above awards by sending an contributions to endourology and the development of email to Ms Marian Smink. Entry requirements for all urologic minimally invasive surgical procedures. The awards mentioned above can be found at EAU Hans Marberger Award is supported by an www.eau16.org/the-congress/awards/

Will you be an EAU Award Winner in Munich?

Apply now and win!

Aside from the four Plenary Sessions, the 19 Thematic Sessions will cover a wide range of urological topics, from paediatric and reconstructive urology to andrology and neuro-urology, among many others.

The well-attended, full-day Live Surgery sessions organised by the ESUT, EULIS and ERUS sections, will take place on Saturday again, unlike in Madrid where the sessions were held on a Monday.

Apply now and win!

Urology Beyond Europe, which aims to engage urologists from outside Europe to present their views and identify regional challenges, will be held on the opening day, Friday, March 11.

Details on the Scientific Programme can be viewed in the next few months whenever specific sessions and speakers are finalised. Regularly check our meeting website at http://eaumunich2016.uroweb.org/scientific-programme/

Award deadline: 1 November 2015 For more information, rules and regulations: www.eau16.org/the-congress/awards

EAU congresses and courses are accredited by the EBU in compliance with the UEMS/EACCME regulations

www.eau16.org

#EAU16

European5 European Urology Today

Association of Urology

Science at your fingertips

www.urosource.com • A single platform with over 50,000 items of scientific content • Accessible everywhere, anytime • Advanced access to content for EAU members

6

European Urology Today

August/September 2015

Road to the future of female SUI surgery Cell-based therapies are underway but better understanding of female SUI is needed Prof. Frank Van Der Aa UZ Leuven ESFFU Board member Leuven (BE) frank.vanderaa@ uzleuven.be Stress urinary incontinence is a very prevalent condition among otherwise healthy women. Sling surgery as a whole has meant an enormous step forward in the treatment of stress urinary incontinence in women. Before 1995, with the introduction of the Tension free Vaginal Tape (TVT), bladder neck suspension techniques were the treatment of choice in many centres around the world.

The SISTEr trial compared the efficacy and safety of the autologous sling procedure with the Burch colposuspension. After randomizing 655 women with SUI and urethral hypermobility to either sling or Burch, the trial reported higher success rates in the sling group at 24 months (Albo et al., 2007). This reflects the concern of many experts on longer follow-up of bladder neck suspension techniques. On the other hand, autologous sling surgery had higher rates of voiding dysfunction (difficulty voiding and urgency incontinence) as well as urinary tract infections. This reflects the obstructive nature of autologous sling surgery.

Synthetic slings are aimed to be placed tension-free and thus should give less obstructive problems.

Although both techniques should be ‘tension-free,’ the retropubic approach (TVT) presents more risk for obstructive problems afterwards. In the TOMUS trial, the rates of voiding dysfunction requiring repeat surgery (sling release) was 2.7% in the TVT group versus 0% in the transobturator group (Richter, Albo, Zyczynski, & Kenton, 2010). These numbers are favourable compared to older techniques, but still a larger group of patients will have voiding symptoms without undergoing surgery to treat these problems.

Both in this TOMUS trial as in meta-analyses, no significant differences in efficacy of retropubic or transobturator tapes were demonstrated so far (Lucas et al., 2012; Richter et al., 2010). Reported efficacy rates vary around 80%. From another viewpoint, still a substantial group of patients will not be cured from the invalidating stress urinary incontinence after sling surgery.

Although safety and efficacy rates favour (synthetic) sling surgery, the use of synthetic material has also introduced risks that are unique to the use of mesh material: mesh extrusion/exposure/erosion. Although the rates of extrusion in sling series are invariably low (less than 5,8% ) mesh issues have received a lot of media attention due to the issues with vaginal mesh repair (Agency, 2012). As such, the use of foreign materials might be unacceptable in certain patients or settings.

From the clinicians’ point of view, decreasing failure and obstruction rates and eliminating the use of permanent foreign materials are desired future developments.

Towards a better understanding of female SUI The exact pathophysiology of female SUI is not well understood. From a theoretical point of view, a distinction between urethral hypermobility and intrinsic sphincter deficiency can be made, but most urologists do not make this distinction in clinical practice. First-line surgery that is offered to patients will be a synthetic sling regardless of the underlying problem. Moreover, in the TOMUS trial, urethral function tests (Mean Urethral Closure Pressure (MUCP) and Valsalva Leak Point Pressure (VLPP)) were not predictable for outcome.

The development of SUI is multifactorial and probably the result of a cascade of events. Pregnancy and vaginal childbirth, major risk factors for the development of SUI, produce mechanical and neurovascular injury to the pelvic floor. Aging, a second major risk factor, also has a negative impact on urethral suspension, innervation and striated and EAU Section of Female and Functional Urology (ESFFU)

August/September 2015

Figure 1: Micro-ultrasound examination using a18-38 MHz probe. The probe is fixed by an arm; the anesthesia table with the rat can be moved to obtain maximal quality images.

Figure 3: Micro-ultrasound image (M, motion-mode) in A) C group, B) mPNI group and C) VD group, showing the presence and absence of IPHFOs activity, where contraction (closing) of the urethral sphincter is represented by the arrow sign.

Figure 2: M-mode representative of a normal lower urinary tract and internal genitalia system anatomy in a female rat: (1) bladder, (2) vagina, (3) urethra, (4) pubic bone and (5) cervix.

The C group showed a constant/rhytmic interval (arrow) with a constant length of contraction (width area of arrow-pointed), while the mPNI group showed various length of contraction within an inconsistent interval/arrhythmic activity. VD group did not show any IPHFO activity at all. The narrowing of area (*) represents leakage of urine of VD group in the absence of IPHFOs.

Human clinical trials are pilot experiments showing safety and feasibility, rather than efficacy data. Muscle derived stem cells have been investigated in several studies, including a dose finding study (L. K. Carr et al., 2008; Lesley K. Carr Are we reaching a new destination? & Webster, 1997; Chancellor et al., 2000; Sèbe et Regenerative medicine offers several possibilities to al., 2011). Currently, a proper multicentre improve current sling systems. On one hand, the randomised placebo controlled trial is being set up development of sling scaffolds seeded with cells (or with chemokines and/or growth factors) can eliminate including several American and European centres.

This will be the first trial to adequately investigate the need for permanent foreign materials in the the efficacy of this type of treatment. Other cell human body. On the other hand, tissue regeneration types that have been injected in a few female (muscle and/or nerve regeneration) by injecting patients are umbilical cord stem cells and adipose various types of stem cells should restore sphincteric derived stem cells (Lesley K. Carr et al., 2013). function.

smooth muscle function. Other elements that promote injured rats (VD and PNC). Moreover, the method is the clinical exposure of diminished urethral and pelvic less operator-dependent, non-invasive and allows the floor functioning are obesity, parity, and menopause. use of fewer animals for experiments.

"Regenerative medicine has the intrinsic possibility to tackle some of the downsides of sling surgery, but is still in its infancy."

Animal models can help us to understand the pathophysiology of female SUI. They are also important for translational research, especially when regenerative options are investigated.

The vaginal distention (VD) model is an acute SUI model that mimics the muscle and nerve injury of childbirth by placing an insufflated intravaginal balloon to distend vagina, bladder neck and urethra for several hours (A. S. Lin, Carrier, Morgan, & Lue, 1998). This model is of specific interest to investigate the underlying mechanisms of injury and repair. Since this is a reversible SUI model (most rats recover after some time to regain continence), the influence of therapies on recovery can be investigated. It has, for example, been shown that mesenchymal stem cells are incorporated in the urethra and vagina after vein tail administration in a VD model.

The construction of scaffolds has not yet outgrown the laboratory phase. As such, this possibility is probably not yet ready for human trials in the next two years.

Cell therapy is somewhat more developed, mainly thanks to the use of cell types in other disciplines such as cardiology and plastic surgery. There exists some translational data and even some clinical trials on stem cell therapy for female SUI in humans. Several cell types have shown beneficial effects on SUI in rat models. Among the reported cell types, muscle derived stem cells (MDC), adipose derived stem cells (ADSC), bone marrow derived stem cells (BMSC) were most commonly reported (Kwon et al., 2006; C. S. Lin & Lue, 2012; Ning, Albersen, Lin, Lue, & Lin, 2013).

A better understanding Female SUI is a prevalent condition affecting many otherwise healthy women. Sling surgery has popularised surgical treatment and has good efficacy and safety records. Regenerative medicine has the intrinsic possibility to tackle some of the downsides of sling surgery, but is still in its infancy. More questions than answers have risen from the first set of experiments with cell-based therapies. The pathophysiology of female SUI should be better understood. The working mechanism of cell-based therapies is still obscure. Nevertheless, the first placebocontrolled randomized trials are underway.

A comparable model, which is more focused on (pudendal) nerve damage as a contributing factor to the development of female SUI, is the pudendal nerve crush (PNC) model. Pudendal nerve crush results in denervation and loss of function (with development of SUI), followed by nerve regeneration and recovery of function (continence) (Herrera-Imbroda, Lara, Izeta, Sievert, & Hart, 2015).

To better understand urethral function, we introduced urethral micro-ultrasound technique in rats (Hakim et al., 2015). This is a non-invasive, reproducible tool to assess urethral function in female rats.

The µUS imaging is performed using an MS-400 transducer (30 Hz) placed longitudinally on the distal-abdomen of rats, focusing on the external urethral sphincter opening and closing (EUS bursting) pattern and analysed using B-mode and M-mode features. Off-line measurement of the EUS bursting is performed using predetermined parameters: rate of bursting (ROB), interbursting interval (IBI), length of bursting (LOB) and total length of bursting (TLB). All parameters are measured in triplicate.

Our results showed that µUS can be used as a standardised and reproducible method to assess urethral function in normal and simulated-birth

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 2016!

For more information and application, please contact the EUSP Office – eusp@uroweb.org or check our website http://www.uroweb.org/education/scholarship/

European Urology Today

7

EAU Research Foundation offer: New scholarship and publication opportunities for researchers The EAU Research Foundation (EAU-RF) aims to build scientific research capacity and promote integration of excellent scientific researchers within the European Urology Research environment. The EAU-RF offers possibilities for young urologists and researchers to develop an independent research career and in doing so strengthen the European urology research environment.

also offers a career development programme for young researchers.

publications. Of course the candidate is free to suggest other directions.

EAU-RF projects This newly-offered scholarship pertains specifically to the EAU-RF’s own projects: the recently completed ZEUS clinical trial, and the Evolution registry.

Apply before October 15!

The EAU-RF is currently looking for researchers who are interested in analysing the data generated by two of its own projects, ZEUS and Evolution, offering scholarship and publication opportunities for researchers.

The EAU-RF, together with the EAU and the European Urology Scholarship Programme, already encouraged researchers to apply to the variety of research-related scholarships on offer, from short clinical visits to longer lab scholarships. The EAU-RF EAU Research Foundation

ZEUS is a 1,433-patient, multi-country randomized clinical trial, which investigates the added effect of Zoledronic Acid together with standard hormonal treatment versus standard hormonal treatment alone in preventing bone metastases in a population of non-metastatic PCa patients at high risk of developing metastases.

Evolution is a registry in which 2,175 patients from five European countries received pharmacological treatment for their LUTS, and were followed for 2 years. Patient Reported Outcomes were collected with various questionnaires. Effects of treatments used in daily practice were analysed in various countries. A health economy analysis is one of aims of this registry.

These two projects are now in the end stage of reporting and reports have been generated for both. Although the initial reports are ready for exchange, there are many opportunities to analyse and publish topics with the sizeable available, cleaned datasets. The steering committee members of ZEUS and Evolution have already proposed directions for additional analyses and

For details on the studies and career development projects and scholarships, please check the Research and Education sections on the EAU website, www.uroweb.org For details of the application process, please contact Ms. Wilma Klijnhout (researchfoundation@uroweb.org) at the EAU Research Foundation.

Candidates may participate in EUSP or EAU Research Foundation Career development programmes or may be young academic urologists who can stay working in their current institution. Candidates will work together with the Clinical Research Director and epidemiologists of the EAU Research Foundation under the mentorship of the project principal investigator or project steering committee member/urologist.

Russian urologist still going strong at 85 Vladimir Tkachuck remains in the frontlines of Russian urology Prof. Igor Korneyev Chair Membership Office St. Petersburg (RU)

iakorneyev@ yandex.ru On June 22 this year Vladimir Tkachuk, professor at the Department of Urology of the First State Pavlov Medical University in St.Petersburg, Russia, celebrated his 85th birthday, a remarkable feat considering that others would have already been enjoying their pension years.

Professor Tkachuk was born in St. Petersburg (Leningrad) and had his medical education and his clinical training in 1955 at the Pavlov Medical University (formerly the Pavlov Medical Institute).

After graduating from medical school he has been

working ever since at the university’s Department of Urology.

One of his first mentors was Professor Ashot Gasparyan, Russia’s outstanding urologist and chairman of the Russian Urological Society. Under his supervision Tkachuk gained experience in clinical urology, scientific research and medical education. He defended his Ph.D. thesis in renal tuberculosis in 1960 and years later received his Master of Science degree for “Conservative treatment of urinary tuberculosis.”

He served as professor and Chairman of the Department of Urology from 1970 until 1995.

Tkachuk was involved in many aspects of urology such as benign prostate hyperplasia, urolithiasis, urinary bladder cancer, urinary tract infections and Russian urology history. He published more than 500 scientific papers in various periodicals and journals in Russia and abroad. He is an editorial board member of several Russian urological journals, including “Urologija” the official journal of the Russian Society of Urology (RSU).

Under Tkachuk’s initiative the Department of Urology has become in 1989 the first ESWL center in Russia’s northwestern region. With the widespread

EAU Membership Office

From 1972 up to the present, Prof. Tkachuk is chairman of the St.Petersburg Fedorov Urological Society, the first professional scientific society of Russian urologists and considered the third oldest in Europe since the society’s establishment in 1907.

Today, the society’s monthly meetings with its key opinion leaders’ panel that generates active discussion and exchanges reflect the dynamism of the city’s urological community.

Prof. Vladimir Tkachuk

use of ESWL equipment in Russia, the center has trained many urologists in neighboring regions and its role was highlighted in two scientific publications. Tkachuk’s expertise was recognized by the St. Petersburg Department of Healthcare when they appointed him as Chief Urologist from 1973 to 1981. Besides his urology career Tkachuk was involved in the university’s international affairs.

From 1970 to 1989 he worked as vice-rector for foreign affairs and helped established friendly ties with medical universities and urologists in Europe, Middle-East, Africa and Asia. He was elected as an honorary member of the Hungarian Association of Urology in 1975.

Tkachuk is still active in the lecture circuit all over Russia and abroad. As an RSU board member and active EAU member Tkachuk participates in the RSU and the EAU’s strategy planning and management.

Under his supervision, St. Petersburg hosted the first EAU/EBU East-West Programme Symposium in 1996, the EAU/ESU education course in andrology in 2000, and the EBU in-service exam.

Professor Tkachuk remains committed to the development of active links between the RSU and EAU relationship as shown by his enthusiastic participation at the ‘EAU Meets the National Societies’ annual meetings. He was unanimously elected as Honorary Chairman of the 15th RSU-EAU Congress which will take place in St. Petersburg from September 18 to 20 this year.

EUSP Scholarship Report Excellent training and support at AKH Vienna Dr. Natalia Musko European Health Centre Otwock Urology Clinic Otwock (PL)

outpatient clinics available such as general urology, andrology, incontinence and oncology (ambulatory).

on the many different aspects of general urology.

Although the meetings were held in German, communicating in English was not a problem.

Three operating rooms are available for the Those three months in Vienna certainly enhanced Department of Urology on a daily basis., and the my oncological knowledge. I would like to thank department is one of the few centres in Austria that the EUSP Board as well as Prof. Shariat, Prof. Seitz perform robotic radical prostatectomy. For locally advanced prostate cancer treatment, open radical prostatectomy is one of the available treatment options. Small renal masses are removed by open and nmusko@gazeta.pl laparoscopic techniques. The department also has experience in robotic partial nephrectomy. The clinic Early this year I started my scholarship at the Medical can also be considered as a urolithiasis centre since University Hospital of Vienna (AKH Wien). The aim of they perform more than 400 stone removal my clinical visit was the diagnosis, treatment and procedures, annually. follow-up of oncological patients with prostate, kidney and bladder cancers. I also planned to Expert guidance develop my laparoscopic skills and acquire more During my clinical visit I received guidance from experience in robotic surgery.

Prof. Shariat who is not only an excellent teacher but also an expert in open surgery. Although I could Prof. Shahrokh Shariat is the head of the Department not work as a consultant, I attended clinic and of Urology and also the adjunct professor at Weill follow-up operations. I also attended minimal Cornell Medical Centre. The Department of Urology at invasive operations besides the many impressive AKH has 60 beds and serves patients admitted either open procedures I have observed. During operations for surgery or chemotherapy. Paediatric urology is Prof. Shariat shared his "tips and tricks" in surgical integrated in the department. There are several techniques that aim to achieve the best functional outcomes for the patient. During daily radiological meetings he also showed me how to perform in European Urological Scholarship Programme Office The Vienna team many oncological cases. Afternoon lectures focused 8

European Urology Today

and the urology team at AKH for their hospitality and great effort in helping me improve my knowledge and skills.

For this wonderful experience I would strongly recommend young urologists to apply for scholarships with the EUSP.

August/September 2015

EAU-RF launches PRECISION Trial New study will compare MRI-targeted prostate biopsy to standard trans-rectal biopsy in PCa patients Dr. Veeru Kasivisvanathan NIHR Doctoral Fellow in Urology University College London Hospitals PRECISION Study Coordinator London (GB) veeru.kasi@ucl.ac.uk The EAU Research Foundation (EAU-RF) has announced the launch of PRECISION Trial, an international multi-centre randomised controlled study that will compare magnetic resonance imaging-targeted biopsy to standard trans-rectal ultrasound guided biopsy for the diagnosis of prostate cancer in men without prior biopsy.

The support at the EAU Research Foundation will come from Wim Witjes, Scientific and Clinical Research Director, Christien Caris, Clinical Project manager and Joke Van Egmond, Data manager.

Background The classical pathway for the diagnosis of prostate cancer is TRUS biopsy of the prostate following a raised PSA. TRUS guidance is performed primarily for anatomic guidance and the ultrasound discriminates poorly between cancerous and non-cancerous tissue.

Biopsies are concentrated in areas of the peripheral zone, which harbors the majority of cancer.

An alternative pathway for the diagnosis of prostate cancer in men with raised PSA is to perform a multi-parametric magnetic resonance imaging (MPMRI) to localize cancer and to use this information to influence conduct of a subsequent biopsy, known as an MPMRI-targeted biopsy. This pathway may offer advantages over the classical pathway.

1 = Highly unlikely to be clinically significant cancer

Below are the potential implications of this trial:

2 = Unlikely to be clinically significant cancer

• Introduction of an alternative prostate cancer diagnostic pathway • A reduction in the number of patients undergoing prostate biopsy • A reduction in the number of biopsy cores taken per patient • A reduction in biopsy-related sepsis, pain and other side effects • A reduction in the over-diagnosis of clinically insignificant prostate cancer • A reduction of the economic burden of diagnosing and treating prostate cancer

3 = The presence of clinically significant cancer is equivocal 4 = Likely to be clinically significant cancer 5 = Highly likely to be clinically significant cancer Areas scoring 3, 4 or 5 will undergo targeted biopsy using the information from the MPMRI to influence biopsy conduct. Up to three suspicious areas will be targeted with a maximum of 4 cores per target leading to a maximum of up to 12 cores per patient.

Visual registration or software-assisted registration may be used.

In the control arm, patients will undergo a standard The PRECISION Trial will assess whether MRI-targeted 10-12 core TRUS biopsy as per standard practice. prostate biopsy is non-inferior to standard 10-12 core Pathologic findings from all biopsies will be recorded Trans-rectal (TRUS) biopsy in the detection of clinically Study design and compared. significant cancer in men without prior biopsy.

The study is an international multi-centre randomised controlled trial, with 470 men randomised in a 1:1 In both arms self-reported questionnaires to capture In a press release, the EAU-RF said the study will ratio to one of two arms. Men will either undergo biopsy-specific side effects will be completed have Caroline Moore and Mark Emberton as chief standard of care biopsy, TRUS biopsy, or will undergo immediately post-procedure and at 30 days. investigators. Joining the team as investigators are a MPMRI and targeted biopsy of suspicious areas.

EQ-5D-5L questionnaires will also be completed at Chris Bangma, Franck Bladou, Alberto Briganti, baseline, 24 hours post-MRI and 24 hours postPieter De Visschere, Nicola Fossati, Jurgen Futterer, Hypothesis biopsy. Men will be followed up for 30 days post Inderbir Gill, Boris Hadaschik, Giles Hellawell, The proportion of men with clinically significant intervention and until a treatment decision is made Richard Hindley, Jonas Hugosson, Veeru cancer detected by MPMRI-targeted biopsy will be no and recorded. Pathology results from men Kasivisvanathan, Laurence Klotz, Drew Moghanaki, less than that detected by standard 12-core TRUS undergoing radical prostatectomy will be recorded.

Francesco Montorsi, Tim Nedas, Valeria Panebianco, biopsy Once men complete the trial they revert to standard Antti Ranniko, Michiel Sedelaar, Paras Singh, Osamu of care.

Ukimura, Inge van Oort, Geert Villeirs, Arnauld Villers Methods The support at the EAU Research Foundation will come from Wim Witjes, Scientific andsupport John Ward.

Mencome referredfrom with Wim clinicalWitjes, suspicionScientific of prostate cancer Patient inclusion criteria The at the EAU Research Foundation will and Clinical Research Director, Christien Caris, Clinical Project manager and Joke Van who have had no prior biopsy are randomised to 1. Men at least 18 years of age referred with clinical and Clinical Research Director, Christien Caris, Clinical Project manager and Joke Van Egmond, Data manager.

The Trial Management Group will be composed of either standard 12-core TRUS biopsy or to a MPMRI suspicion of prostate cancer who have been Egmond, Data manager.

Chris Brew-Graves, Norman Williams, Ingrid Potyka arm. In the MPMRI arm, areas of the prostate are advised to have a prostate biopsy (UCL Clinical Trials Group), Fatima Jichi scheme (UCL scored on a 5-point scale of suspicion for clinically 2. Serum PSA ≤ 20 ng/ml [SUBHEAD, BOLD] Study Biostatistics) BOLD] and Susan Tebbsscheme (UCL CCTU). significant cancer: 3. Suspected stage ≤ T2 on rectal examination [SUBHEAD, Study (organ-confined prostate cancer) Below is a graphic flow chart of PRECISION Trial’s study scheme: 4. Fit to undergo all procedures listed in protocol Below is a graphic flow chart of PRECISION Trial’s study scheme: Study scheme 5. Able to provide written informed consent Below is a graphic flow chart of PRECISION Trial’s study scheme:

"Institutions with expertise in MRIprostate biopsy can take part in this study. Sites are expected to recruit between 30-50 men in 12 months."

Man with no prior biopsy referred with clinical suspicion of prostate cancer targeted Man with no prior biopsy referred with clinical suspicion of prostate cancer

Registration (n=470) Registration (n=470) 1:1 Randomisation 1:1 Randomisation Arm 1 (n=235) Arm 1 (n=235) Multi-parametric MRI Multi-parametric MRI MpMRI MpMRIscore 1,2 score 1,2

MpMRI MpMRI score 3,4,5 score 3,4,5

No biopsy No biopsy

MRI-targeted MRI-targeted biopsy of the biopsy of the prostate prostate

Patient exclusion criteria 1. Prior prostate biopsy Arm 2 (n=235) 2. Prior treatment for prostate cancer Arm 2 (n=235) 3. Contraindication to MRI (e.g. claustrophobia, pacemaker, estimated GFR ≤ 50mls/min) 4. Contraindication to prostate biopsy 10-12 core trans-rectal biopsy of 5. Men in whom artifact would reduce the quality 10-12 core trans-rectal biopsy of the prostate of the MRI the prostate 6. Previous hip replacement surgery, metallic hip replacement or extensive pelvic orthopaedic metal work 7. Unfit to undergo any procedures listed in protocol

Results given Results given Results given Decision Results given Decision Treatment Treatment TreatmentQuestionnaire Decision TreatmentQuestionnaire Decision Questionnaire Questionnaire

Primary Outcome: PrimaryProportion Outcome: of men with clinically significant cancer detected

Proportion of men with clinically significant cancer detected

Secondary Outcomes include: Secondary Outcomesofinclude: 1. Proportion men with clinically insignificant cancer detected

1.

2.

3.

Proportion of men with clinically insignificant cancer detected 2. Proportion of men with negative MPMRI who avoid biopsy Proportion of men with negative MPMRI who avoid biopsy 3. Maximum cancer core length of most involved biopsy core Maximum cancer core length of most involved biopsy core

EAU Research Foundation

August/September 2015

Study outcomes Primary outcome Proportion of men with clinically significant1 cancer detected

Results given Results given Decision Treatment TreatmentQuestionnaire Decision Questionnaire

Secondary outcomes include 1. Proportion of men with clinically insignificant cancer detected 2. Proportion of men in MPMRI arm who avoid biopsy 3. Cancer core length of the most involved biopsy core (maximum cancer core length, MCCL) 4. Proportion of men with post-biopsy adverse events 5. Health-related quality of life scores 6. Cost per diagnosis of cancer

Participating centres The following centres in 10 countries are participating in the PRECISION Trial:

Belgium • Ghent University Hospital Canada • Jewish General Hospital • Sunnybrook Medical Centre Finland • Helsinki University Central Hospital France • CHU Lille, University Lille Nord de France Italy • Sapienza University of Rome, Italy • San Raffaele Hospital, Milan Germany • University Hospital Heidelberg Netherlands • Erasmus University Medical Centre • Radboud University, Nijmegen Medical Centre Sweden • University of Gothenburg United Kingdom • Basingstoke and North Hampshire Hospital • Northwick Park Hospital • Royal Free Hospital NHS Foundation Trust • University College London Hospitals USA • McGuire VA Hospital, Richmond • MD Anderson Cancer Centre, Texas • USC Institute of Urology, Keck School of Medicine, University of South California Is the study open to new sites?

Yes. Institutions with expertise in MRI-targeted prostate biopsy can take part (e.g. centres with published results of MRI-TB or audit data of detection rates of MRI-TB at their centre).

To those who are interested, please contact the study coordinator on veeru.kasi@ucl.ac.uk. Sites are expected to recruit between 30-50 men in 12 months.

Funding The EAU-RF provide their web-based database management system for collection of patient data and some funding for European centres for research activity associated with taking part in the PRECISION study (e.g. clinical research nurse time for case report form completion). Funding is on a per-patient recruited basis.

The study coordinator, Veeru Kasivisvanathan, is funded by a UK NIHR Doctoral Research Fellowship (DRF-2014-07-146).

Study registration and status The study is part of the UK Clinical Research Network, 1 Clinically significant cancer will be evaluated on a per ID 18902 (ISRCTN 18440098 NCT02380027). The study patient basis from needle biopsy according to two is due to open for recruitment imminently in the UK definitions: and the study completion date is estimated on October 2017.

• Definition 1: clinically significant cancer is defined as a single core containing Gleason Grade 3+4 disease or greater.

• Definition 2: clinically significant cancer is defined as a single core containing Gleason Grade 4+3 disease or greater.

European Urology Today

9

A chance to join the ...

International Academic Exchange Programme Canadian Urological Association (CUA) in collaboration with the European Association of Urology (EAU)

2016 Canadian Tour The European Association of Urology (EAU) and the Canadian Urological Association (CUA) are pleased to announce the 2016 Canadian tour!

The CUA/EAU International Exchange Programme will send Canadian faculty to Europe and European faculty to Canada. The programme aims to promote international exchange of urological medical skills, expertise and knowledge.

Information and application forms For all further information and programme application forms please visit www.uroweb.org, and select International Relations, CUA-EAU International Academic Exchange Programme or contact the EAU Central Office, T +31 (0)26 389 0680, F +31 (0)26 389 0674, E: a.terberg@uroweb.org.

Application deadline: 1 November 2015

For 2016 the CUA/EAU International Exchange Programme will provide grants to enable three Junior EAU Members to participate in the Canadian Tour. The tour should take place from 12-28 June 2016 starting with visits to different urological centres in Canada, culminating with participation at the CUA Annual Meeting to be held in Vancouver.

EAU Central Office, Attn. Angela Terberg, P.O. Box 30016, 6803 AA Arnhem, The Netherlands

Eligibility criteria • Less than 42 years of age • Minimum academic rank of assistant professor • Letter from the departmental chairman of the applicant’s commitment to academic medicine • Membership of the EAU • Availability to travel around 2,5 to 3 weeks at the earlier mentioned time

Canadian Urological Association (CUA)

Win a free registration to Munich in 2016!

EU-ACME members, join the MCQ quiz published in European Urology

14-18 sEptEmbEr Urology Week is an initiative of the European

For details, visit: www.eu-acme.org/europeanurology

Association of Urology, which brings together national urological societies, urology practitioners, urology nurses and patient groups to create awareness of urological conditions among the general public.

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10

European Urology Today

D13907-EN

August/September 2015

Advances in laparoscopy for urological indications - Part 1 Prospects and trends in minimally invasive surgery Prof. Jens Rassweiler Dept. of Urology SLK Kliniken Heilbronn (DE)

jens.rassweiler@ slk-kliniken.de

Ass. Prof. Dogu Teber UniversitätsKlinikum Heidelberg Dept. of Urology Heidelberg (DE) Germany dogu.teber@Med. uni-heidelberg.de Co-Authors: Jan Klein, Ali Serdar Gözen Since end of last century, there has been a tremendous development replacing open surgery by minimally invasive or even non-invasive surgery.

This was accomplished by continuous improvement of video-endoscopic technology, implementation of physical principles and even the introduction of robot-assisted surgery.1 In a series of articles, we aimed to summarize upcoming technology and also speculate on future patterns of minimally invasive surgery (MIS), respectively, the future of laparoscopy in urology.

Basically, this concerns development in (i) videoendoscopy, (ii) endoscopic armamentarium, (iii) surgical platforms, single-port surgery (iv), and (v) robot-assisted surgery.

Review criteria An intensive literature research was performed using Medline / PubMed using the keywords “laparoscopy new development (n=194)”, “laparoscopy video technology (N=507)”, “laparoscopy sealing devices (n=161)”, ” laparoscopy flexible instruments (n=276)”, “laparoscopy ergonomics (n=790)“, “laparoscopy camera holder (n=37)”, “laparoendoscopic single site surgery (n=726)”, “robot-assisted surgery in urology (1306)” from 1999 to 2015. Additionally, an Internetresearch (web, figures, videos) was accomplished to pick up all relevant novelties in the field of laparoscopic surgery. Articles were filtered according to the above-mentioned criteria. Moreover, we added personal experience, albeit unpublished, concerning some of the presented issues (i.e. flexible instruments, suturing devices).

Table 1: Review of technical data of present and future videosystems Videosystem

Pixels

Frame Rate (fields/sec)

Standard Definition TV (SDTV)

640x480

60 (NTSC; US/ 4:3 Japan)

640x576

50 (PAL; Europe)

High Definition TV (HDTV)

Picture Aspect Ratio

4:3

1920x1080

60 (US/Japan) 16:9

1920x1080

50 (Europe)

Ultra-High Definition TV (Ultra HDTV-4K) 4096x2160 (Ultra HDTV-8K) 7680×4320

16:9

120

16:9

120

16:9

whereas the Ultra HD consumer format provides a slightly lower resolution of 3840 X 2160 (Table 1).

Consequently it shows eight million pixels compared to two million pixels of full HD providing finer anatomic details, greater tissue-texture and a quasi-photographic emulsion of smoothness of the video-image.6 Such a quantum leap may help endoscopic surgeons increase the actual image quality particularly concerning zooming/magnification of the video-signal to almost microscopic dimensions (Fig. 1). Thereby, some of the actual drawbacks of 3D-HD-technology might be overcome. However, future studies have to analyse the real clinical impact of such optical improvements for endourology and laparoscopy.7 3D-Video-technology One problem of classical laparoscopy is the twodimensional view of a telescope. The surgeon has problems to determine spatial distances due to absence of shadows, stereovision and parallax movement.8 Surgeon’s experience may compensate these difficulties with a small working field and with the camera close to the object.

shutter glasses. However, this was abandoned due to the fact that only the surgeon had a normal endoscopic picture whereas assisting nurses and the anaesthesiologist had double-image on the screen.

Moreover, the shutter movements were tiring for the surgeon`s eyes.8 Subsequently, a 3-D-system was introduced which takes two images with one telescope from different angles followed by digital image-reconstruction.

Polarised glasses quite similar to sunglasses were able to produce a three-dimensional image, whereas without glasses the picture on the screen was normal.

However, the system could only be realized for 0°-lenses and the image significantly lost brightness compared to classical CCD-camera.10 Another approach was the use of 3D-helmets with two displays thereby creating the three-dimensional image. However, the image quality of the small monitors was insufficient in resolution and the helmets were inconvenient for the surgeon (Fig. 1a).

Thus, such systems were not used in clinical routine.10 The current technological generation has developed the 3D-HD-videotechnology which is available for 0° and 30° telescopes. There is still the need to use polarised glasses with subsequent reduction of image brightness (Fig. 2a). HD-technology may compensate partly this loss. Moreover, the angle of the surgeons to the video-monitor is critical for an optimal 3D-image.

Another option includes flexible 3D/HD-laparoscopes Fig. 2: Actual modifications of 3D-HD-videotechnology (Fig. 2b) which are mainly advantageous for a) HD-3D-system applicable for 0° and 30°-lenses (ie. Karl laparoscopic sigmoidectomy or NOTES-assisted Storz, Tuttlingen, Germany) transvaginal nephrectomy.11 b) HD-3D-flexible laparoscope (Olympus, Tokyo, Japan),

Evidently, a console-based system as realized in Da-Vinci-systems (SI/XI) consisting of two HD-screens fused by mirror-technology represents the optimal solution which is even better than an operative microscope.1 It remains open, whether Ultra-HD may compensate the disadvantages of bedside-based laparoscopic systems. Six degrees of freedom (6-DOF)-instruments require 3D-videotechnology for Surgeon’s depth perception can be improved by a number of aids. An illumination cannula (second light optimal application. Earlier comparative studies comparing 2D versus 3D-vision failed to show any source) may provide shadows in the working field.9 advantages for the experienced surgeon indicating, Stereo-endoscopic systems accomplish stereovision.

Initially two 5 mm-CCD-lenses were integrated in one that magnification, brightness and sharpness provided by 2D-HD may compensate loss of telescope creating a double-image on the monitor.

The two images were unified to a 3D-picture by use of stereovision.12

Development in video-endoscopy HD-technology and beyond Introduction of high-definition (HD) video-technology with significant improvement of image-quality (resolution, brightness, depth and magnification) compared to CCD (three-chip)- or even one-chiptechnology, enabled laparoscopic surgeons to safely perform complicated procedures such as radical cystectomy with intraoperative reconstruction of neo-bladders.2 Recently, Lusch et al. demonstrated a significantly higher resolution (14.3 vs. 4.0 line pairs/ mm), colour representation and depth of field when comparing HD-digital sensor to a standard fibre-optic cystoscope.3 Initially, criticism against laparoscopic surgery was focussing on minor quality of endoscopic images compared to open surgery resulting in surgical errors due to misinterpretation of patient`s anatomy.4 Actually the scenario has changed completely: Quality of endoscopic images exceeds by far the capacities of the human eye and due to the significantly larger distance eye-object compared to the used telescope (i.e. in case of radical prostatectomy 70 cm vs. 5-7 cm), this cannot be compensated completely by the use of magnifying glasses or microscopic systems.5 However, information technology is under continuous development and 4K Ultra HD TV is already on the way to consumer entertainment industry representing a derivation of 4K digital-cinema standard. Multiplex cinema displays images in 4096 x 2160 resolution, Expert views

August/September 2015

Fig. 1: Development of video-technology a) Head-set for 3D-CCD-videotechnology (Viking, USA). Quality of 3D-image suboptimal. Inconvenient for surgeon due tot he weight of head-set. b) CCD-technology during laparoscopic partial nephrectomy (lower monitor). Upper monitor displays augmented reality based on preoperative computed tomography c) HD-technology during laparoscopic partial nephrectomy (left monitor). Right monitor displays augmented reality based preoperative computed tomography. d) Ultra-HD as next generation of entertainment industry (ie. Samsung, Japan).

mainly for surgical use (ie colonic surgery) or NOTESassisted transvaginal nephrectomy.

On the other hand, the recent study of Cicione et al. clearly demonstrated an advantage of threedimensional imaging for urologic surgeons without laparoscopic background using a validated program for laparoscopic skills.13 References 1. Rassweiler, J., Binder, J., Frede, T. Robotic and telesurgery: will they change our future. Curr. Opinion in Urology 11, 309-320 (2001) 2. Albisinni, S., et al. Long-term analysis of oncologic outcomes after laparosopic radical cystectomy in Europe: Results from a multicentric study of EAU-section of Uro-Technology. BJU Int 115, 937-945 (2015) 3. Lusch, A., et al. Comparison of optics and performance of distal sensor high definition cystoscope, a distal sensor standard definition cystoscope, and a fiberoptic cystoscope. Urology 85, 268-272 (2015) 4. Schurr, M.O., Kunert, W., Arezzo, A., Buess, G. The role and future of endoscopic imaging systems. Endoscopy 71, 557-562 (1999) 5. TrueVision, Microsurgery Teaching System, available at www.truevisionsys.com 6. Acharya, S. Ultra high definition televsion: Treshold of a new age. ITU, press release, www.itu.int, May 24 (2012) 7. Bach, T., et al. Technical solutiona to improve the management of non-invasive transitional cell carcinoma: summary of European Association of Urology Section of Uro-Technology (ESUT) and Section for Uro-Oncology (ESOU) expert meeting and current and future perspectives. BJU Int, 115, 14-23 (2015) 8. Rassweiler, J., Frede, T. Robotics, telesurgery and telementoring – their position in modern urological laparoscopy. Arch. Esp. Urol. 55, 610-628 (2002) 9. Breedveld, P., Stassen, H.G., Meijer, D.W., Stassen, L.P.S. Theoretical background and conceptual solution for depth perception and eye-hand coordination problems in laparoscopic surgery. Min. Invas. Ther.&Allied Technol. 8, 227-234 (1999) 10. Rassweiler, J., Gözen, A.S., Frede, T., Teber, D. Laparoscopy vs. Robotics: Ergonomic – does it matter? In: Hemal, A.K., Menon, M. (eds.) Robotics in Genitourinary Surgery, Springer pp. 63-78 (2011) 11. Izquierido, L. et al. Recent advances in natural orifice transluminal endoscopic surgery in urologic surgery. Int. J. Urol. 20, 462-466 (2013) 12. McDougall, et al. Comparison of three-dimensional and three dimensional laparoscopic video systems. J. Endourol 10, 371-374 (1996) 13. Cicione, A. et al. Three-dimensional vs standard laparoscopy: comparative assessment using a validated program for laparoscopic skills. Urology 82, 1444-1450 (2013)

European Urology Today

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Key articles from international medical journals Dr. Francesco Sanguedolce Section editor London (UK)

fsangue@ hotmail.com

Can we predict response to novel anti-androgens in CRPC? The development of novel drugs to disrupt the androgen pathway in prostate cancer has shown as increase in overall survival in patients with metastatic castration resistant prostate cancer. However, as not all patients benefit from these expensive treatments there is an urgent need to identify predictive biomarkers to assist decision-making in patients with CRPC. Intense translational research efforts are on-going but have not yet yielded clinically applicable solutions. This paper investigates ready-to-use clinical predictors of improved outcome to predict progression-free survival in patients treated with these novel androgen receptor axis-targeted drugs.

The data was collected by pooling information from two French cancer centres. Only those men with accurate data on the initiation of ADT and the development of CRPC were included. Biochemical progression was defined according to the Prostate Cancer Working Group 2 (PCWG2) criteria.

Radiological progression was defined according to the RECIST 1.1 criteria. Biochemical or PSA response was defined as a ≥50% decline of baseline serum PSA levels. Time to castration resistance was calculated from the time of ADT initiation irrespective of stage until confirmation of CRPC. Data on patient and disease were collected: metastatic site(s), type of pretreatment progression (biochemical, clinical or radiological), time to CRPC, number of prior endocrine therapies, Eastern Cooperative Oncology Group (ECOG) performance status, PSA value and pain.

This paper provides some initial data to support the commonly held view that failure to respond to ADT is predictive of shorter PFS and lower efficacy in patients treated with next-generation AR axistargeted drugs Data was available on 173 patients. Median time to the development of CRPC was 17.8 months. Most patients (68%) had also received docetaxel chemotherapy with a median time to progression of 6.7 months and the median pretreatment PSA was 69 ng/dl. Patients received a variety of antiandrogen treatments (Enzalutamide 33%, Bicalutamide 26%, Oestrogens 22%, Aberaterone 10%, Ketoconazole 9%). Of the factors analysed pretreatment ECOG score (p = 0.004) and time to CRPC (p = 0.002) significantly impacted PFS. In multivariate analysis both time to CRPC of equal or greater than 12 months (HR 0.66; CI 0.46-0.94, p = 0.02) and ECOG score 0-1 (HR 0.58: CI 0.36-0.94, p = 0.03) were correlated with improved PFS. In the subgroup of 57 patients treated with enzalutamide after previous chemotherapy median PFS was 2.8 months and 8.6 months (p = 0.0016) and the 50% PSA response rate was 8% vs 58% (p < 0.001) in patients with a time to CRPC of under and over 12 months respectively.

This paper provides some initial data to support the commonly held view that failure to respond to ADT is predictive of shorter PFS and lower efficacy in patients treated with next-generation AR axistargeted drugs. This is not entirely surprising as time-to-progression to CRPC has previously been shown to be an independent predictor of overall survival. The question remains: does this also affect response to chemotherapy? That is: are these just aggressive cancers or is it the androgen axis alone which has mutated allowing the tumour to remain responsive to other therapies.

Key articles

12

Source: Prior long response to androgen deprivation predicts response to nextgeneration androgen receptor axis targeted drugs in castration resistant prostate cancer.

Loriot Y, Eymard J-C, Patrikidou A, iIeana E, Massard C, Albiges L, Di Palma M, Escudier B, Fizazi K. European Journal of Cancer (2015) http://dx.doi. org/10.1016/j.ejca.2015.06.128.

Can we use exercise programmes to improve health outcomes in men treated for prostate cancer?

symptoms (effect size: d, 20.35; 95% CI, -0.71 to 0.02; p = 0.06). Eighty percent of participants reported that the clinician’s referral influenced their decision to participate in the exercise programme.

Although the study failed to reach its primary endpoint the men in the intervention condition undertook more than twice as much vigorous exercise at follow-up and had almost four times the odds of meeting exercise guidelines (≥ 150 min/wk of MVPA) and nearly five times the odds of avoiding complete inactivity than men in the control condition. There also appeared to be significant psychological gains and an improved sense of well-being. In this short-term study, whether the programme is sustained over time was not evaluated but that will determine the potential to improve the medium- and long-term health outcomes for men living with the disease.

Mr. Philip Cornford Section editor Liverpool (GB)

philip.cornford@ rlbuht.nhs.uk score categories. Interestingly there was a suggestion that men with no co-morbidity suffered more than those with existing co-morbidity.

In this study, ADT was associated with a 9.5% increase in OCM at 10 years after prostate cancer diagnosis. This implies that at 10 years follow-up, Men living with prostate cancer and the consequences ADT use was linked to an increase risk of mortality of prostate cancer treatments have complex physical Source: Effects of a clinician referral and exercise program for men who have completed due to causes other than cancer in one out of 10 and psychological needs effecting quality of life. As patients receiving this treatment modality. It is not we become increasingly aware of these survivorship active treatment for prostate cancer: A multicentre cluster randomized controlled trial possible to rule out an association, rather than a issues efforts are being focused upon reducing direct effect and it does not give any clues to the treatment-related toxicities, preventing secondary (ENGAGE). Livingston PM, Craike MJ, Salmon J, mechanism by which this effect occurs. However, it comorbidities and enhancing functional capacity.

Courneya KS, Gaskin CJ, Fraser SF, Mohebbi M, would suggest the effect is time dependent and as Broadbent S, Botti M, Kent B and the ENGAGE such it is important that we carefully consider the Exercise has been shown to have a positive impact on Uro-Oncology Clinicians’ Group. indication for initiation of ADT Cancer 2015;121: 2646-2654 clinical outcomes and one strategy to encourage this is through a referral to an exercise programme tailored to individual capabilities in partnership with Source: Medical androgen deprivation and allied health personnel. increased non-cancer mortality in nonThis paper presents data from a two-armed prospective multicentre cluster randomised trial evaluating the effects of a medical or nursing clinician referral to a 12-week exercise programme (comprising two gym sessions and one home-based session per week and commencing three to 12 months after active treatment for prostate cancer) in comparison with usual care.

Fifteen clinicians agreed to take part and were randomly allocated into either intervention or control groups. Postgraduate clinical exercise physiology students under the supervision of accredited exercise physiologists instructed participants during two supervised, 50-minute sessions per week at local gym facilities, and they advised participants on a weekly home-based session. All participants were asked to wear a hip-mounted accelerometer for seven days at the baseline and immediately after the 12-week programme.

The primary outcome was the number of selfreported minutes of moderate-vigorous physical activity (MVPA) per week as measured with an adapted Godin- Shepherd Leisure Time Exercise Questionnaire. The secondary outcomes included an objective assessment of physical activity as well as self-reported depressive symptoms, anxiety, and quality of life.

There also appeared to be significant psychological gains and an improved sense of well-being Quality of life was measured with the European Organization for Research and Treatment of Cancer core quality- of-life questionnaire (QLQ-C30, version 3) and prostate tumour–specific module (QLQ-PR25).

Prostate cancer–related anxiety was measured with the Memorial Anxiety Scale for Prostate Cancer (MAX-PC). Depressive symptoms were assessed with the 20-item Center for Epidemiological Studies Depression Inventory, with mean and total scores calculated.

Of 741 men screen for the study, 443 were eligible and 230 were approached, 142 in the intervention arm, and 178 in the control arm of these 54 in the control arm and 93 in the control arm consented to take part.

Participant had a mean age of 65.6 years with a range of 39-84 years. A significant intervention effect was observed for vigorous-intensity exercise (effect size: Cohen’s d, 0.46; 95% CI, 0.09-0.82; p = 0.010) but not for combined moderate and vigorous exercise levels (effect size: d, 0.08; 95% CI, -0.28 to 0.45; p = 0.48).

Significant intervention effects were also observed for meeting exercise guidelines (≥ 150 min/wk; odds ratio, 3.9; 95% CI, 1.9-7.8; p = 0.002); positive intervention effects were observed in the intervention group for cognitive functioning (effect size: d, 0.34; 95% CI, -0.02 to 0.70; p = 0.06) and depression

Medical androgen deprivation and increased non-cancer mortality

Medical androgen deprivation therapy (ADT) is a commonly prescribed treatment for men with prostate cancer. It has an established role in men with metastatic disease and as an adjuvant to radiotherapy when treating high-risk or locally advanced disease.

However, it also has a detrimental impact on quality of life by increasing the risk of several morbidities, including impaired cognitive function, loss of muscle strength, anaemia, bone loss or fractures, heart disease, and diabetes mellitus. This data has raised the possibility that ADT could increase the risk of other cause mortality. A hypothesis given more impetus when review of the degerelix data suggested it might be associated with a decreased risk of non-prostate cancer deaths when compared to LHRH agonists.

This study took data from the SEER-Medicare database. They identified 389,097 men with prostate cancer aged ≥ 66 years and diagnosed between January 1995 and December 2009. From these, patients were excluded if they had prostate cancer diagnosis not as first or only tumour (n = 31,786), had an unknown zip code (n = 3,225), had incomplete Medicare Part A and Part B claims/enrolled in a health maintenance organization (n = 141,052), diagnosed at autopsy/death certificate only (n = 3,398), had unknown historic stage (n = 16,924), had metastatic disease (n = 9,548), were treated with orchiectomy (n = 5,706) or initial observation (n = 39,934).

…ADT was associated with a 9.5% increase in OCM at 10 years after prostate cancer diagnosis

metastatic prostate cancer patients aged ≥66 years. Abdollah F, Sammon JD, Reznor G, Sood A, Schmid M, Klett DE, Sun M, Aizer AA, Choueiri TK, Hi JC, Kim SP, Kibel AS, Nguyen PL, Menon M, Trinh Q-D. European Journal of Surgical Oncology (2015), http://dx.doi.org/10.1016/j.ejso.2015.06.011.

Long-term active surveillance outcomes in low-risk prostate cancer Active surveillance (AS) entails a strategy by which selected men are managed expectantly with the intention to apply potentially curative treatment in case of progression signs. This option is widely used in low-risk and very low-risk prostate cancer patients.

Nevertheless, long-term oncologic outcomes are still lacking.

This long-term follow-up study confirms that AS for low-risk prostate cancer is safe in the 15-year time frame The present series from the University of Toronto reports the longest follow-up from a prospective AS cohort. Overall, 993 patients were included in this phase II trial opened in 1995, and 844 were alive at analysis time. AS was offered to all low-risk patients (Gleason score < 6 and PSA < 10 ng/mL) and to patients older than age 70 years with PSA < 15 ng/mL or Gleason score < 4+4 (7).

Criteria for intervention were Gleason score upgrading at re-biopsy, clinical progression and/or PSA doubling time < 3 years. Nevertheless, the protocol withdrew PSA kinetics as criterion for This yielded a total of 137,524 assessable patients. intervention in 2009 given the lack of predictive value For each patient, data regarding age, race, year of for outcomes. Median follow-up from the first biopsy diagnosis, population density, marital status, stage, Gleason score, primary treatment type and duration of was 6.4 years. Out of 149 deaths, only 15 were ADT was extracted. A list of 40 possible comorbidities attributable to prostate cancer. The 10- and 15-year overall survival rates were 80% and 62%, was identified and appearance of the codes in the respectively. The actuarial cancer-specific survival 12 months prior to diagnosis was sorted. rates were 98.1% and 94.3%, respectively.

Average age at diagnosis was 74.2 years. The most The cumulative hazard ratio for non-prostate-tofrequent primary treatment was radiotherapy prostate cancer mortality was 9.2:1. Metastasis (51.2%) and overall 57.7% of patients received ADT disease occurred in 28 patients (2.8%), and median with a mean duration of 22.9 months. Overall time to metastasis was 7.3 years. Twenty-seven median follow-up time was 60.4 months. At 10 percent of patients underwent intervention. The 5-, years the other cause mortality rate was 30.6% in 10-, and 15-year treatment-survival rates were 75.7%, patients treated without ADT and 40.1% in those 63.5%, and 55%. In the University of Toronto series, treated with ADT (p < 0.001). In a Cox multivariable the overall rate of Gleason score upgrading over time regression analysis patients treated with ADT had a was 31%. Interestingly, the median age of men was higher other cause mortality (HR 1.11 95% CI higher than in the other series. No strong difference 1.08-1.13, p < 0.001). in terms of cancer-specific survival was established.

However, the all-cause mortality was superior in that These findings were confirmed, when patients were series. stratified into sub-cohorts according to comorbidity

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August/September 2015

Prof. Oliver Hakenberg Section Editor Rostock (DE)

Oliver.Hakenberg@ med.uni-rostock.de PSA doubling time and upgrading at rebiopsy were the most common causes for deferred treatment. Age, tumour stage, PSA values, Gleason score, number of cores involved at baseline and on confirmatory biopsy were significantly linked to biopsy progression.

This long-term follow-up study confirms that AS for low-risk prostate cancer is safe in the 15-year time frame. The cancer-specific mortality rate is consistent with expected mortality in the same risk category patients managed with initial definitive intervention.

Given the lack of randomized trials comparing surveillance versus immediate treatment (SAMS and ProsPect trials are on-going), these findings provide the current highest level of evidence for AS recommendation in low-risk patients.

Source: Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. Klotz L, Vesprini D, Sethukavalan P et al.

J Clin Oncol 2015; 33: 272-277.

PUL men. Two patients (6%) in the TURP group required surgical intervention for adverse events.

Importantly, IPSS, Qmax and PVR were significantly more improved after TURP than after PUL showing the superiority of TURP in terms of objective urinary flow measurements.

To summarize, recovery after PUL was faster than after TURP and ejaculatory function was preserved.

Nevertheless, regarding efficacy measures, PUL did not do as well as TURP. Larger comparative with longer follow-up are needed to confirm these results and to evaluate whether benefits of PUL are sustainable.

Source: Prospective, randomized, multinational study of prostatic urethral lift versus transurethral resection of the prostate: 12-month results from the BPH6 Study. Sonksen J, Barber NJ, Speakman MJ, et al.

Eur Urol 2015, In Press.

Regarding ejaculatory function, the PUL group experienced a significant improvement in average ejaculatory score from baseline. Conversely, the TURP group suffered from a significant decline regarding this outcome. Overall, fewer treatment-related infections were reported in the PUL group: 7% versus 14%. However, the difference was not significant. No surgical re-intervention or revision was observed in Key articles

August/September 2015

Eur Urol, 2015, http://dx.doi.org/10.1016/j. eururo.2015.05.015.

Changes in LUT symptoms and QoL after salvage radiotherapy in PCa patients

Prediction of continence and hypercontinence after radical cystectomy with neobladder in women Urinary incontinence and hypercontinence are frequently observed in women after ileal orthotopic bladder substitution following radical cystectomy (RC). Surgical dissection leads to denervation lesions of the most proximal urethra with consecutive atrophy and consequences on continence status.

In 81 patients who received SRT (70Gy/35fr/7weeks), International Prostate Symptom Score (IPSS), 36-Item Short Form scores, and UCLA-Prostate Cancer Index (UCLA-PCI) were recorded before, during, and immediately after SRT, and one to 12months after the completion of SRT.

Thus, in addition to the need for perfect cancer control, the optimisation of the functional outcomes after this radical surgery remains a challenge. Studies have shown that nerve-sparing procedures as well as the preservation of uterus could impact on this Transurethral resection of the prostate (TURP) remains post-operative continence status. Unfortunately, very few data are available. the reference treatment for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Alternatives to standard TURP that may lead to In the present series, 73 women undergoing RC with significant morbidity and long-term complications are ileal orthotopic neobladder were prospectively followed with urethral pressure profiles (UPP) continuously assessed. performed before and after surgery at various The prostatic urethral lift (PUL) is a minimally invasive intervals. All UPP results were re-evaluated by a single expert. The cohort included four women (5.5%) procedure that involves transurethral placement of who underwent RC for post-radiation cystitis and 69 small, permanent UroLift implants. The aim of such for invasive urothelial cancer. Hysterectomy had been devices is to retract the lateral lobes of the prostate performed previously in 22% of cases and at the time and, thereby, to decrease urinary tract obstruction. of RC in 42.5%. Nerve sparing was attempted Multiple implants are placed to de-obstruct the bilaterally in 38 patients (52%) and unilaterally in 31 prostatic urethra.

(42.5%). After surgery, patients were instructed on how to void the bladder substitute by relaxing the This series report the findings from a prospective, pelvic floor and exerting only minimal abdominal randomized, non-blinded study that was conducted straining. across three European countries. The PUL was compared to monopolar or bipolar TURP. The main endpoint was a composite of six elements that assess For data analysis, four groups were separated according to the final postoperative clinical findings. overall outcome, BPH6. LUTS relief, quality of Group 1 was continent with spontaneous voiding and recovery, erectile function, ejaculatory function, no PVR (n = 36). Group 2 was incontinent with continence preservation and safety, assessed by the spontaneous voiding and no PVR (n = 17). Group 3 Clavien-Dindo classification, were included.

Unfortunately, Qmax and IPSS were only evaluated as was incontinent with PVR (n = 13). Group 4 was continent with PVR and no mechanical outlet secondary endpoints. The study was powered to obstruction (n = 7). establish non-inferiority of PUL to TURP for noninferiority delta of 10% for the BPH6 primary endpoint after a 12-month follow-up.

…recovery after PUL was faster than after TURP and ejaculatory function was preserved

Source: Orthotopic ileal bladder substitution in women: Factors influencing urinary incontinence and hypercontinence. Gross T, et al.

The aim of the authors was to evaluate chronologic changes in lower urinary tract symptoms (LUTS), health-related (HR) quality of life (QoL), and disease-specific QoL during the first 12 months after salvage radiotherapy (SRT) for biochemical recurrence of prostate cancer in patients who underwent radical prostatectomy.

Prostatic lift: An efficient therapeutic option for BPH management?

Overall, 80 men were enrolled: 45 PUL versus 35 TURP. In the PUL arm, multiple implants (mean 4.7) were placed to de-obstruct the prostatic urethra.

The proportion of patients achieving the BPH6 recovery endpoint by one month was 82% in the PUL group, as compared with 53% in the TURP group (p = 0.008). The average number of days to discharge was significantly lower (1.0 vs 1.9 d) and the return to preoperative activity levels was significantly faster (11 vs 17 d) for PUL than for TURP patients. No difference in terms of continence or erectile function was observed between both groups. No patient experienced new-onset stress or sphincter incontinence.

nerve sparing techniques significantly improved functional outcomes. All these predictive factors should be taken into account for patient counselling before surgery. However, due to the low number of patients, no clear pre-operative continence product was identified to anticipate the post-operative continence status.

…postoperative continence status correlates with the pre- and postoperative UPP findings

The uterus was preserved in 51% of postoperatively continent patients compared with 13% of incontinent patients (p < 0.01). The functional urethral length, the maximal urethral closing pressure at rest, and the continence product were also higher in patients with uterus preservation compared with hysterectomised patients. Patients with bilateral nerve sparing also had the highest continence product. The UPP demonstrated that postoperatively continent patients had a longer preoperative functional urethral length (+5 mm) compared with incontinent patients.

Differences in preoperative maximal urethral closing pressures at rest and continence product were also shown between both groups. If the pre-operative continence product was >3000 cm H2O x mm, the risk of incomplete voiding was high (50%). Findings also suggested that continence recovery could be delayed and that the return to continence was correlated with significant improvements in terms of functional urethra length and maximal urethral closing pressure at rest.

To summarise, postoperative continence status correlates with the pre- and postoperative UPP findings. Moreover, preservation of the uterus and

Knowledge of changes in LUTS and QoL outcomes associated with SRT may influence treatment recommendations and enable patients to make better-informed decisions The total IPSS and storage symptom-related sum were significantly increased following initiation of SRT, and returned to the baseline six months after SRT. For three of eight domains of HRQoL, and the physical component summary score showed transient deterioration in the period between completion of SRT and one month following SRT. The UCLA-PCI for urinary function/bother and bowel function/bother was affected until one to six months after SRT. This paper is the first to concurrently evaluate detailed chronologic changes in LUTS and QoL in patients who received SRT. Knowledge of changes in LUTS and QoL outcomes associated with SRT may influence treatment recommendations and enable patients to make better-informed decisions.

Source: Changes in lower urinary tract symptoms and quality of life after salvage radiotherapy for biochemical recurrence of prostate cancer. Miyake M, Tanaka N, Asakawa I, Tatsumi Y, Nakai Y, Anai S, Torimoto K, Aoki K, Yoneda T, Hasegawa M, Konishi N, Fujimoto K. Radiother Oncol. 2015 May 16. doi: 10.1016/j. radonc.2015.04.026. [Epub ahead of print]

Clinically and statistically significant changes seen in sham surgery arms of randomised controlled BPH surgery trials

Prof. Oliver Reich Section editor Munich (DE)

oliver.reich@ klinikummuenchen.de Initial search yielded a total of 1998 potential studies.

After review of abstracts and full text articles, a total of 14 RCTs were included in some part. An average decrease from 22.3 to 16.7 (-27%) was seen in studies looking at the AUASS at three months after sham endoscopic procedure (p=0.0003) with an increase in Qmax of 1.3mL/sec (14%, p=0.001) at three months.

Decreases in prostate injection based studies at three months were similar with a decrease from 21.3 to 15.7 (-26%, p<0.001). Qmax increased by 2.0mL/sec (23%, p=0.043).

…sham controlled endoscopic and injection BPH interventions demonstrate a considerable and statistically significant change in symptom scores and Qmax…

The authors concluded that sham controlled endoscopic and injection BPH interventions demonstrate a considerable and statistically significant change in symptom scores and Qmax that is comparable to the response seen in medication trials.

Future uncontrolled BPH surgical trials should consider these findings when interpreting their outcomes.

Source: Clinically and statistically significant changes seen in sham surgery arms of randomized controlled benign prostatic hyperplasia surgery trials. Welliver C, Kottwitz M, Feustel P, McVary K. J Urol. 2015 Jul 1. doi: 10.1016/j.juro.2015.06.091.

[Epub ahead of print]

Use of PDE5 Inhibitors for erectile dysfunction and risk of malignant melanoma The target for the oral erectile dysfunction drugs, phosphodiesterase type 5 (PDE5) inhibitors, is part of a pathway implicated in the development of malignant melanoma. An increased risk of melanoma in sildenafil users was recently reported.

The authors conducted a population-based, nested case-control study in the Swedish Prescribed Drug Register, the Swedish Melanoma Register, and other healthcare registers and demographic databases in Sweden, including 4,065 melanoma cases diagnosed from 2006 through 2012 and five randomly selected controls per case with matching year of birth. The aim was to identify the risk of melanoma; overall and by stage and risk of basal cell carcinoma in multivariable logistic regression analyses.

The risk estimates were similar for sildenafil and vardenafil or tadalafil.

PDE5 inhibitor use was also associated with an increased risk of basal cell carcinoma…

Of 4,065 melanoma cases, 435 men (11%) had filled prescriptions for PDE5 inhibitors, as did 1,713 men of 20,325 controls (8%). In multivariable analysis, there was an increased risk of melanoma in men taking PDE5 inhibitors (OR, 1.21 [95% CI, 1.08-1.36]).

The most pronounced increase in risk was observed in men who had filled a single prescription (OR, 1.32 [95% CI, 1.10-1.59]; exposure rate, 4% for cases vs 3% for controls), but was not significant among men with multiple filled prescriptions (for 2-5 prescriptions: A systematic review of available literature was undertaken looking for randomised controlled trials OR, 1.14 [95% CI, 0.95-1.37], 4% for cases and 3% for (RCTs) involving endoscopic or intra-prostatic injection controls; for ≥ 6 prescriptions: OR, 1.17 [95% CI, BPH treatments that included a sham surgical arm 0.95-1.44], 3% for cases vs 2% for controls). from January 1990 to February 2015. Studies that included an objective symptom questionnaire and PDE5 inhibitors were significantly associated with maximum urinary flow (Qmax) at three months were melanoma stage 0 (OR, 1.49 [95% CI, 1.22-1.83], 13% for cases vs 8% for controls) and stage I (OR, 1.21 included. Results were analysed together with weighting based on study sample size.

[95% CI, 1.02-1.43], 12% for cases vs 10% for While medication trials frequently involve a placebo arm to more fairly assess efficacy of the study drug, benign prostatic hyperplasia (BPH) surgery trials rarely include a sham surgery group due to the inherent risks associated with simulating treatment in these patients. Resultantly, the placebo response to a sham surgery for BPH is largely unknown.

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13

Prof. Truls Erik Bjerklund Johansen Section editor Oslo (NO)

tebj@medisin.uio.no controls), but not stage II through IV (OR, 0.83 [95% CI, 0.63-1.09], 6% for cases vs 7% for controls).

The risk estimates were similar for sildenafil and vardenafil or tadalafil. PDE5 inhibitor use was also associated with an increased risk of basal cell carcinoma (OR, 1.19 [95% CI, 1.14-1.25], 9% for cases vs 8% for controls). Men taking PDE5 inhibitors had a higher educational level and annual income, factors that were also significantly associated with melanoma risk.

In a Swedish cohort of men, the use of PDE5 inhibitors was associated with a modest but statistically significant increased risk of malignant melanoma. However, according to the authors, the pattern of association raises questions about whether this association is causal.

Source: Use of phosphodiesterase type 5 inhibitors for erectile dysfunction and risk of malignant melanoma. Loeb S, Folkvaljon Y, Lambe M, Robinson D, Garmo H, Ingvar C, Stattin P. JAMA. 2015 Jun 23-30;313(24):2449-55. doi: 10.1001/ jama.2015.6604.

Medical expulsive therapy: Game over for alpha-blocker and nifedipine The EAU guidelines in urolithiasis recommend the use of alpha blockers and nifedipine (GR A) for the medical treatment of ureteral stones on the basis of the findings of several meta-analysis showing a benefit in terms of a quicker expulsion rate and a better control of pain (LE 1a).

However, these meta-analysis pooled data from small -low quality- randomised controlled trials (RCT), so that in their conclusions they highlighted the need for a large RCT to confirm the reported outcomes. This is also the reason why the evidence was not enough to allow the indication of these drugs in this setting of patients, hence the need to prescribe them off-label.

A multi-centre, UK-based, large RCT placebo controlled –SUSPEND- was designed to address this issue: it consisted of a three-arm study, including one group of patients treated with tamsulosin 400 mcg, one with nifedipine 30 mg, and another group with placebo, for a four-week period.

A total of 1167 patients were recruited and randomly allocated into the three groups, achieving a 90% study power to address the hypothesis that tamsulosin group patients would have been able to pass stone in a 10% proportion higher than nifedipine group. A post-hoc analysis included the comparison of the active treatment groups versus placebo.

Randomisation was double-blinded and generated remotely by a system allocated at the Centre for Healthcare Randomised Trial in Aberdeen.

…the authors firmly concluded that the evidence provided is strong enough to rule out any clinical benefit of either tamsulosin or nifedipine to assist stone passage for patients affected by ureteric stones Inclusion criteria included patients affected by renal colic for single ureteric stone, ≤ 10 mm at the largest diameter, detected at CT KUB at the diagnosis, and with age less than 65 ys. Interestingly, the authors did not assess stone passage at four weeks by the use of imaging as CT scan was not considered cost-effective, and X-ray KUB and US KUB were deemed not accurate enough. They rather based the outcome on the need of intervention as a reliable clinical measurement which also reflects the normal clinical practice.

Key articles

14

However, they also considered the case of persistent asymptomatic stones that did not trigger any intervention during the four-week period of observation: they assumed that these patients would have required any intervention by Week 12 in any case, either because of late recurrence of symptoms or because of abnormal clinical features at the follow-up (impaired renal function, imaging showing persistency of stones, etc.). For this reason, they conducted a secondary analysis at the 12 weeks time-point.

No difference was found in terms of spontaneous stone passage during the four weeks of treatment: intervention was needed in 19 vs 20 vs 20% in the tamsulosin, nifedipine and placebo group, respectively.

No differences were identified also in the sub-groups analysis for sex, stone size (< 5 mm vs ≥ 5 mm) and stone location (proximal, mid and distal ureter).

No differences were either noticed in terms of days of analgesic therapy, time-to-stone passage and health status (assessed by Short Form -36 questionnaire) between groups. No differences were even noticed when they analysed the proportion of patients who needed intervention by Week 12 across the three groups.

On the basis of the results achieved with this robustly designed study, the authors firmly concluded that the evidence provided is strong enough to rule out any clinical benefit of either tamsulosin or nifedipine to assist stone passage for patients affected by ureteric stones. It is likely that these findings will have a significant impact on the future versions of the international guidelines.

Source: Medical expulsive therapy in adults with ureteric colic: a multicentre, randomised, placebo-controlled trial. Pickard R, Starr K, MacLennan G, Lam T, Thomas R, Burr J, McPherson G, McDonald A, Anson K, N'Dow J, Burgess N, Clark T, Kilonzo M, Gillies K, Shearer K, Boachie C, Cameron S, Norrie J, McClinton S. Lancet. 2015 May 18. pii: S0140-6736(15)60933-3. doi: 10.1016/S0140-6736(15)60933-3. [Epub ahead of print]

Super-selective clamping of renal artery and off-clamp techniques during partial nephrectomies: New challenges for whom and for which benefits?

Nephron sparing surgery (NSS) has almost replaced radical nephrectomy for T1a renal masses. In recent years, technical innovations have been introduced to maximise the benefits from a Partial Nephrectomy (PN) and these have included the super-selective clamping of the tributary segmental artery (MIPN) or the Off-clamp technique (Off-C).

Their theoretical advantage consists in the minimal or zero warm ischemia and the lack of stitches in the parenchyma that can increase the loss of functioning healthy tissue.

A systemic review has been recently conducted to explore in detail the different techniques and the outcomes related to them: 52 papers were selected following the PRISMA guidelines.

Almost all the techniques have been introduced with the advent, firstly, of the laparoscopic surgery and then more significantly of the robotic surgery. Most of papers selected showed that the MIPN and Off-C techniques were associated with longer operative times and higher blood loss; however, transfusion rate was not always significantly higher than On-Clamp (On-C) standard technique and complication rates were commonly similar.

The main advantage seemed to rely on a better post-operative renal function, with higher estimated eGFR and less pronounced increase of serumcreatinine: however, these factors are not reliable indicators of the loss of the functioning renal parenchyma and are not necessarily related to the risk of long-term Chronic Kidney Disease (CKD), especially in case of patients with two functioning kidneys and normal baseline renal function.

The authors identified only one study comparing functional outcomes by the use of renal scintigraphy showing that at three months post-operatively renal scans were similar comparing MIPN and On-C; however, it was highlighted that MIPN was most

beneficial in patients with the lowest baseline renal function. Similar results have been identified in other series where the MIPN or the Off-C partial nephrectomies were conducted in the cases of solitary kidneys.

Anyway, most of comparative publications are biased by patients’ selections, as most of the Off-C or MIPN patients had lower nephrometry scores (R.E.N.A.L. ≤ 7; PADUA ≤ 8) and smaller tumours (≤ 3 cm); the introduction of this bias, of course, has played a significant role on the functional outcomes across the relevant studies whose results at the end need to be considered very carefully.

MIPN and Off-C NSS are techniques established in referral centres for selective cases, which advantage is mainly appreciable in patients with decreased baseline renal function

Dr. Guillaume Ploussard Section editor Toulouse (FR)

g.ploussard@ gmail.com At a median follow-up of 67 months (range 18-84) the five-year Recurrence Free (RFS), Cancer Specific (CSS) and Overall (OS) Survival rates were 67, 75 and 50%, respectively.

On multivariate analysis, non-organ confined and positive lymph nodes were predictor factors for RFS, CSS and OS (Hazard Ratio: 2.12 and 1.08; 4.78 and 1.11; 3.60 and 1.07, respectively); interestingly, PSM predicted only the recurrence-free survival in the same analysis (HR: 2.16). Overall, organ-confined, PSM, positive lymph node rates as well as the survival rates in this study were comparable to those historically reported for ORC.

The authors of the systematic review did not perform any meta-analysis likely because of lack of randomised controlled trials and of the poor quality of the data available, hence their call for prospective On the other hand, the lymph node yield of 16 is randomised trials. lower than the range reported for either historical ORC or other RARC cohorts; notably, Interestingly, they also highlighted the need for a only 26% of patients had > 15 nodes removed. Of standardised way to report the different resection and course it is impossible to assess whether this renorrhaphy techniques as proposed by some other factor may have played a role in the outcomes or authors more recently with the aid of a validated not; however, it is interesting to note that the score, the Superficial-Intermediate-Base (SIB) score. authors found a higher percentage of distant metastasis than local recurrences (63% vs 19%) In conclusion, MIPN and Off-C NSS are techniques with a mean time to recurrence of 356 and 458 established in referral centres for selective cases, days, respectively. which advantage is mainly appreciable in patients with decreased baseline renal function.

Sources: 1) Indications, techniques, outcomes, and limitations for minimally ischemic and off-clamp partial nephrectomy: A systematic review of the literature. Simone G, Gill IS, Mottrie A, Kutikov A, Patard JJ, Alcaraz A, Rogers CG. Eur Urol. 2015 Apr 25. pii: S0302-2838(15)00322-X. doi: 10.1016/j.eururo.2015.04.020. [Epub ahead of print]

2) Evaluation of functional outcomes after laparoscopic partial nephrectomy using renal scintigraphy: clamped vs clampless technique.

Porpiglia F, Bertolo R, Amparore D, Podio V, Angusti T, Veltri A, Fiori C. BJU Int. 2015 Apr;115(4):606-12. doi: 10.1111/bju.12834.

Epub 2014 Oct 22.

3) Histopathological validation of the surfaceintermediate-base (SIB) margin score for standardized reporting of resection technique during nephron-sparing surgery. Minervini A, Campi R, Kutikov A, Montagnani I, Sessa F, Serni S, Raspollini MR, Carini M. J Urol. 2015 Jun 2. pii: S0022-5347(15)04104-X. doi: 10.1016/j.juro.2015.05.086. [Epub ahead of print]

Expanding indications for robotic surgery: Roboticassisted radical cystectomies Robotic-Assisted Radical Cystectomy (RARC) is becoming an expanding indication for robotic surgery.

Some high-volume tertiary referral robotic centres are regularly performing this procedure, mainly for the organ-confined or recurrent high-grade non-muscle invasive bladder cancers.

A recent systematic review showed in a cumulative analysis no significant differences in terms of lymph node yield and positive surgical margins (PSM) rates with respect to open radical cystectomy (ORC); no long-term oncologic outcomes for RARC were available, but trends of survival rates at five-year were similar to those reported to ORC.

The paper has several limitations: the main one is given by the heterogeneity of the data collected across several institutions with different surgeons’ experience and different follow-up protocols The paper has several limitations: the main one is given by the heterogeneity of the data collected across several institutions with different surgeons’ experience and different follow- up protocols.

Moreover, we don’t know the proportion and impact of the RARC in the learning curve as the cohort includes all the cases performed in the relevant institutions.

Finally, there are still open questions not yet answered: functional data are widely missing and, more importantly, there are no conclusive results to provide a superiority of RARC over ORC (or even to laparoscopic RC) to make it cost-effective or to justify its higher costs.

Sources: 1.) Long-term oncologic outcomes following robot-assisted radical cystectomy: Results from the international robotic cystectomy consortium. Raza SJ, Wilson T, Peabody JO, Wiklund P, Scherr DS, Al-Daghmin A, Dibaj S, Khan MS, Dasgupta P, Mottrie A, Menon M, Yuh B, Richstone L, Saar M, Stoeckle M, Hosseini A, Kaouk J, Mohler JL, Rha KH, Wilding G, Guru KA. Eur Urol. 2015 May 15. pii: S0302-2838(15)00323-1. doi: 10.1016/j.eururo.2015.04.021. [Epub ahead of print]

2) Systematic review and cumulative analysis of oncologic and functional outcomes after robot-assisted radical cystectomy. Yuh B, Wilson T, Bochner B, Chan K, Palou J, Stenzl A, Montorsi F, Thalmann G, Guru K, Catto JW, Wiklund PN, Novara G. Eur Urol. 2015 Mar;67(3):402-22. doi: 10.1016/ j.eururo.2014.12.008. Epub 2015 Jan 2.

Interventions for preventing

More recently, the largest series on long-term oncologic outcomes after RARC has been published by recurrent UTI during the International Robotic Cystectomy Consortium pregnancy (IRCC); of the 2,187 patients in the prospectively populated database, 743 with the RARC undertaken ≥ 5 years before were selected for the study, and 702 Recurrent urinary tract infections (RUTI) are common were finally included in the analysis. in women who are pregnant and may cause serious adverse pregnancy outcomes for both mother and The authors reported a 62% of organ-confined child including pre-term birth and small-fordisease, PSM rate of 8%, a mean lymph node yield of gestational-age babies. Interventions used to prevent 16 (range: 10-24 nodes) with 21% positive.

RUTI in women who are pregnant can be

EAU EU-ACME Office

European Urology Today

August/September 2015

EAU Crystal Matula Award Winner 2014: Shahrokh Shariat • What do you think is the biggest challenge in oncology?

The challenge to identify the right patient, for the right treatment at the right time. In other words, to deliver safe, appropriate, and effective care with enduring results, at reasonable cost.

• If you were not a urologist, what would you be?

I would still be in medicine. But my biggest passion is history and understanding how history has changed our lives and the world. I would like to do something that can contribute to a transformative and profound change towards a better world.

• What is your most important piece of advice for doctors just starting out?

Believe in yourself. Dream big and don’t waste time on unimportant issues.

Be ready and start as early as possible. Be courageous. Give back to your community. Love what you do and do what you love. Work hard and put the extra hours in. Believe in what you do and always ask why you do it.

• What is the most rewarding aspect of being a doctor?

Doctors today face many challenges and have many roles. The most rewarding is making a difference in patient’s lives and their families. I also find fulfilment in teaching the next generation of doctors, in putting that fire in their hearts.

• What is your advice to other physicians on how to avoid burnout?

As long as you do what you love, you’re not going to burnout.

• If you could change something in the healthcare system, what would it be?

Each healthcare system has its specific problems. I would try to put the patient again in the centre. We talk about technology and progress, but the main focus should be on the patient. We have to shift to disease prevention through lifestyle changes and emphasise early diagnosis and detection.

• What’s the last wonderful book you have read?

‘Siddhartha’ by Hermann Hesse. Maybe I have read this book more than six times. This is a book that has opened my mind in many levels and taught me that uunderstanding and enlightenment is achieved through the totality of conscious events of a human life.

• What’s the last thing that surprised you?

One thing that always surprises me is the fragility of life and how little we do to remind ourselves of that.

• What’s your favourite hour in a day and why?

It used to be the late hours when I can reflect on things. Now it has changed to the morning hours, when I wake up full of energy and looking forward to what can be accomplished.

TEN QUESTIONS Interview and Photograpy by Joel Vega

pharmacological (antibiotics) or non-pharmacological (cranberry products, acupuncture, probiotics and behavioural modifications).

The objective of the present paper was to assess the effects of interventions for preventing RUTI in pregnant women. The primary maternal outcomes were RUTI before birth (variously defined) and pre-term birth (before 37 weeks). The primary infant outcomes were small-for-gestational age and total mortality. The authors searched the Cochrane Pregnancy and Childbirth Group's Trials Register (20 May 2015) and reference lists of retrieved articles.

Selection criteria were published, unpublished and ongoing randomised controlled trials (RCTs), quasi-RCTs, clustered-randomised trials and abstracts of any intervention (pharmacological and non-pharmacological) for preventing RUTI during pregnancy (compared with another intervention, placebo or with usual care). Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.

…a daily dose of nitrofurantoin and close surveillance has not been shown to prevent RUTI compared with close surveillance alone.

The review included one trial involving 200 women and was at moderate-to-high risk of bias. The trial compared a daily dose of nitrofurantoin and close surveillance (regular clinic visit, urine cultures and antibiotics when a positive culture was found) with close surveillance only. The authors of the review paper concluded that a daily dose of nitrofurantoin and close surveillance has not been shown to prevent RUTI compared with close surveillance alone.

A significant reduction of ASB was found in women with a high clinic attendance rate and who received nitrofurantoin and close surveillance. There was limited reporting of both primary and secondary outcomes for both women and infants. No conclusions can be drawn regarding the optimal intervention to prevent RUTI in women who are August/September 2015

Age: 42 Specialty: Urology City: Vienna, Austria Current Post: Professor and Chairman, Department of Urology, Comprehensive Cancer Center, Medical University Vienna, General Hospital; Adjunct Professor of Urology and Medical Oncology, Weill Cornell Medical College, New York; Adjunct Professor of Urology, University of Texas Southwestern, Dallas, TX, USA.

pregnant. Randomised controlled trials comparing different pharmacological and non-pharmacological interventions are necessary to investigate potentially effective interventions to prevent RUTI in women who are pregnant.

Source: Interventions for preventing recurrent urinary tract infection during pregnancy.

Schneeberger C, Geerlings SE, Middleton P, Crowther CA. Cochrane Database Syst Rev. 2015; 7:CD009279.

Catheter-associated UTI in Intensive Care Unit patients The objective of the present study was to delineate the epidemiology of catheter-associated urinary tract infections (CAUTIs) and to better understand the value of urine cultures for evaluation of fever in the intensive care unit (ICU) setting.

• What do you most often wish you could say to patients, but didn’t?

I’m always honest with the patient, asking if they want to hear the facts and what they may need to know. I often say I have no magic solution. Much of the communication with patients happens with body language and through rituals like examining the patient. We miss these rituals now because we lack the time, unfortunately. I wish I could communicate to each patient how much I care about them.

A total of 18 patients (18%) had fever due to non-infectious cause, and 32 patients (32%) had no alternative explanation. Of these, 66% received appropriate empiric antimicrobial therapy, but no targeted therapy changes were made based on urine culture results. The other 34% did not receive antimicrobial therapy at all. Only 6% of all CAUTIs resulted in blood cultures positive for the same organism within two days. The urinary tract was not definitely established as the source of bloodstream infection.

with infections from ESBL-producing strains were provided, as was information about efficacy against Pseudomonas aeruginosa.

The authors concluded that urine cultures obtained for evaluation of fever form the basis for identification of CAUTIs in the ICU. However, most patients with CAUTIs are eventually found to have alternative explanations for fever. CAUTI is associated with a low complication rate.

…practitioners in the clinical setting who are treating patients with complicated, hospitalacquired, Gram-negative IAIs and UTIs need to consider the possibility of polymicrobial infections and antibiotic-resistant organisms

Source: Catheter-Associated Urinary Tract Infections in Intensive Care Unit Patients.

Tedja R, Wentink J, O'Horo JC, Thompson R, Sampathkumar P.

Authors carried out a two-year retrospective review (2012-2013) in a single tertiary centre with 1,200 hospital beds and 158 adult ICU beds. The patients studied were ICU patients with a CAUTI event. The cohort was identified from a prospective infection prevention database and charts were reviewed to characterise the patients. CAUTI rates and device utilization ratio (DUR) were calculated and clinical outcomes were recorded.

Infect Control Hosp Epidemiol. 2015 Jul 20:1-5.

…most patients with CAUTIs are eventually found to have alternative explanations for fever.

CAUTI is associated with a low complication rate

Empiric therapy for healthcare-associated infections remains challenging, especially with the continued development of Gram-negative organisms producing extended-spectrum β-lactamases (ESBLs) and the threat of multi-drug-resistant organisms. Current treatment options for resistant Gram-negative infections include carbapenems, tigecycline, piperacillin-tazobactam, cefepime, ceftazidime, and two recently approved therapies, ceftolozanetazobactam and ceftazidime-avibactam.

A total of 105 CAUTIs were identified using the National Health and Safety Network (NHSN) definition. Fever was the primary indication for obtaining urine culture in 102 patients (97%). Of these 105 patients, 51 (51%) had an alternative infection to explain the fever, with pneumonia (55%) being the most common followed by bloodstream infection (22%).

Empiric therapy for hospitalacquired, Gram-negative complicated intra-abdominal infection and complicated UTI

Clinical trial evidence to guide selection of empiric antibiotic therapy in patients with complicated, hospital-acquired, Gram-negative IAIs and UTIs is limited. Though most of the clinical trials explored in this overview enrolled patients with complicated infections, often patients with severe infections and multiple comorbidities were excluded.

The authors concluded that practitioners in the clinical setting who are treating patients with complicated, hospital-acquired, Gram-negative IAIs and UTIs need to consider the possibility of polymicrobial infections and antibiotic-resistant organisms, and/or severely ill patients with multiple comorbidities.

There is a severe shortage of evidence-based research to guide the selection of empiric antibiotic therapy for many patients in this setting. New therapies recently approved or in late-stage development promise to expand the number of options available for empiric therapy of these hospital-acquired, Gram-negative infections.

Source: Empiric therapy for hospital-acquired, Gram-negative complicated intra-abdominal infection and complicated urinary tract This systematic literature review surveyed the infections: a systematic literature review of published clinical trial evidence available since 2000 current and emerging treatment options. in support of both current and emerging treatment options in the settings of complicated intra-abdominal Golan Y. infection (cIAI) and complicated urinary tract infection (cUTI). When available, clinical cure rates for patients

BMC Infect Dis. 2015; 15(1):313.

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A long-term biobank of kidney precursors Is it possible to create a bank of kidney precursors for successful transplants?

Dr. César VeraDonoso Dept. of Urology University Hospital La Fe Valencia (ES) cdveradonoso@ gmail.com Co-authors: Ximo García-Domínguez, Silvia VicenteFerrer, Estrella Jimenez-Trigos, Jose S. Vicente, Francisco Marco-Jimenez, Urology Department, University and Polytechnical Hospital La Fe, Institute of Animal Science and Technology, Polytechnic University of Valencia, Spain.

Up to now kidney transplantation is the most efficient therapeutic method. However, allogeneic kidney transplantation is limited due to the shortage of available organs.

Although a possible solution could be the transplantation of vascularized renal xenografts, to date, and for many reasons, this kind of organ is not available for humans. In this field, the transplantation EAU Section of Transplantation Urology (ESTU)

of embryonic precursors is a promising option.

Several advantages have been described with the use of metanephros instead of mature kidneys. A transplanted metanephros obtains its vascularization mainly from the recipient. Thus, the hyperacute and the acute rejection are attenuated and this fact may eventually allow transplantation by breaking the barrier between species. Up to now, the transference of renal primordia has been performed by open surgery from mouse to rat, pig to rat, etc. For the first time, we have approached laparoscopically xenotransplantation of metanephros.

In a first phase, we wanted to know the feasibility of laparoscopic allogenic transplantation of metanephroi (M) in rabbits. Successively, 18 rabbits were subjected to implantation of metanephroi by one port abdominal laparoscopy. A needle was inserted percutaneously to reach the target area in retroperitoneal fat. With an epidural catheter we deposited the metanephros close to a patent blood vessel. Three weeks later, animals were explored by open surgery. Comparison of maturity embryos, morphometric variables of metanephroi and develop rate of transplanted metanephroi were analysed. 10/20 M 15 days old (50%) and 12/26 M 16 days old (46,1%) grew and differentiated such that glomeruli, proximal and distal tubules, and collecting ducts with normal structure had developed. No relevant immunological changes were detected in peripheral blood.

New continence centre and urodynamic lab in Budapest Centre undergoes full renovation and new extension Dr. Attila Majoros Head, Continence Centre & Urodynamic Lab Dept. of Urology Semmelweis University Budapest (HU)

2014 was a significant milestone in the history of the Urodynamic Lab. Following the initiative and dedicated support of the current director, Prof. Peter Nyirády, the laboratory was renovated for expansion to about three times its former area. Moreover, the equipment of the laboratory complies with European standards. The centre was also renamed to the current Continence Centre & Urodynamic Lab.

majorosat@web.de

The Centre offers excellent educational opportunities to medical students, doctors (postgraduate courses), and nurses. The measurements can be projected by video equipment to the clinic’s classroom. Besides the modern urodynamic examinations, the staff members perform complete treatments of male and female urinary incontinence and voiding problems, neurogenic bladder dysfunction and female pelvic organ prolapses.

As part of its goals to improve service delivery in the field of incontinence and urodynamics, the EBUcertified Urologic Department of Semmelweis University has recently invested in a new continence centre.

The Urodynamical Lab of Semmelweis University was established in 1980 as one of the first clinics of its kind in Europe. During the first few years the examinations of the lower urinary tract dysfunctions were carried out with analogue urodynamical measuring instruments. The Urodynamical Lab played an important role in continence management in Hungary. In the succeeding years, and due to the increasing patient numbers, the centre was relocated to a bigger place in 2000.

The clinic’s director at that time also approved the purchase of a new, state- of-the-art urodynamic device (a computer-connected digital measuring instrument). Modern surgical treatments to treat incontinence were also introduced and the conservative and minimal invasive therapies of overactive bladder were extended (to different types of anticholinergics, botulinum toxin, etc.).

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European Urology Today

This last phase has been awarded with the Rene Küss Prize at the last EAU Congress in Madrid (March 2015).

Fig. 1: Own kidney of a rabbit compared with a recovered neokidney from transplanted metanephros

Laparoscopic metanephroi transplantation is a non-invasive and feasible technique without immunological changes from the 15th day in rabbits.

Engraftment of renal primordia transplanted directly into other non-related rabbits did not require host immune suppression (*Study was granted the 2nd Prize for Best Non-Oncology Abstract, EAU Congress, Stockholm, April 2014).

In the second phase we tackled and aimed to solve another real problem. Even if supply and demand could be balanced using xenotransplants or lab-grown organs from regenerative medicine, the future of these treatments would still be compromised by the ability to physically distribute the organs to patients in need and to produce these products in a way that allows adequate inventory control and quality assurance.

Then, kidney precursors originating from fifteen-dayold rabbit embryos were vitrified using Cryotop as a device and VM3 as vitrification solution.

After three months of storage in liquid nitrogen, kidney precursors were transplanted into non-

Several authors have shown that transplantation of metanephroi and subsequent urinary anastomosis to receptor significantly prolonged the life of anephric animals. In addition, most recent results show that transplanted metanephroi are capable of maintaining the blood pressure in anephric rats with acute induced hypotension, as well as diminished vascular calcification in rats with chronic renal failure. This suggests that transplanted metanephros accomplish multiple metabolic renal functions, such as the production of renin and erythropoietin in detectable serum level and also the production of urine.

"After three months of storage in liquid nitrogen, kidney precursors were transplanted into nonimmunosuppressed adult hosts by laparoscopy surgery."

Several questions remain: At which time does metanephros get its maximal growth inside the host?

How long would this kind of transplantation be life-supporting? Finally, for us the challenge of breaking the barrier of species with our model remains. We are working on this challenge right now and we hope to answer these questions this year.

Join us Down Under for: • A scientific programme featuring renowned urological experts in research, education and surgical technique • Rapid-fire debates, master classes, surgical demonstrations and more • Collaboration with attendees from developing markets • New insights and global perspectives on urology beyond Europe

Urodynamic Lab of the new Centre

In recent years the use of adjustable bands, artificial urinary sphincter implantations for male urinary incontinence treatment, as well as prolapse surgery for women with synthetic or ‘own material’ became commonly used in the clinic. In 2013 we also performed the first sacral neuromodulation with the involvement of a neurosurgeon.

The centre’s bigger space now enables the staff members to run parallel examinations which leads to shorter waiting lists. The centre also offers interdisciplinary consulting hours (together with gynaecologists) besides its core services in neurogenic and non-neurogenic urinary incontinence and voiding difficulties, and the management of female pelvic organ prolapses including diagnostic, conservative and surgical therapy.

Opening of the new Centre. From left: A. Egry, Vice Mayor, Prof. Á. Szél, Rector of Semmelweis University, Prof. P. Nyirády, Director of Urologic Department of Semmelweis University

immunosuppressed adult hosts by laparoscopy surgery. Twenty-one days after allotransplantation, 50% of them have become new kidneys. All the new kidneys recovered exhibited significant growth and mature glomeruli. Having achieved these encouraging results, we report for the first time that it is possible to create a long-term biobank of kidney precursors as an unlimited source of organs for transplantation, facilitating the inventory control and distribution of organs.

www.siu-urology.org

Featuring the

SIU-ICUD Joint Consultation on Image-Guided Therapy in Urology and the

SIU Inaugural Nurses’ Education Symposium

A powerful resource for urologists

At your fingertips, anywhere, any time.

We very much hope that our new centre will lead to a faster and more efficient patient care.

5088_SIU2015__EUT_JUNE_Ad.indd 1

2015-05-27 1:222015 PM August/September

ESU participates in HUA’s Biennial Scientific Meeting Thessaloniki meeting tackles uro-oncology issues Dr. Theodoros Kalogeropoulos Urology Consultant Secretary, UroOncology Section Hellenic Urology Association Athens (GR) tkaloger@yahoo.com

“Modern Management of Upper Tract Urothelial Carcinoma,” as topic and chaired by Professors Bertrand Malavaud (FR) and Oliver Hakenberg (DE).

The well-attended course provided updated information regarding the management of upper tract urothelial carcinoma, a topic that often receives limited attention in international meetings but remains a challenge in everyday practice. The course ended with a challenging case presentation presented

by Prof. Giannakopoulos, with commentary from an international panel as well as the ESU faculty.

The Uro-oncology Section of the Hellenic Urologic Association (HUA) held last June 12 to 14 the 6th PanHellenic Biannual Scientific Meeting in Thessaloniki, Greece as part of HUA’s aims to provide the latest urological updates and advances to its members.

The meeting also gave special focus on developments in prostate cancer (PCa) treatment including updates on the current management of all stages of the disease, from localised to castrate-resistant PCa. Bladder, testis and renal cancers were also tackled during the meeting and thoroughly discussed by speakers with multidisciplinary backgrounds.

Since uro-oncology patients usually require a multidisciplinary approach, special attention was given to this approach with various roundtable discussions, debates and satellite symposia featuring experts from medical oncology and radiation oncology.

The scientific programme covered current issues and controversies in uro-oncology including best practices and recent developments in the field. Around 250 participants attended the meeting.

Besides the plenary sessions and lectures, the programme also offered a 2.5-hour course organised by the European School of Urology (ESU) with

The ESU course and sessions of the meeting were recorded and can be viewed online without a log-in code at http://www.livemedia.gr/6th_panhellenic_ meeting_huanet

Prof. Evangelos Liatiskos leading the discussion

Residents and young urologists were also given the opportunity to present their work in a moderated poster session and awards were granted to the best poster presentations. An international faculty from nearby Balkan countries also attended the meeting and actively took part in various sessions

Faculty member of the HUA meeting and ESU Faculty members, Prof. S. Giannakopoulos (left), Prof. B. Malavaud (middle) and Prof. O. Hakenberg (right)

contributing to a dynamic exchange of urological knowledge in the region.

The success of the meeting and the positive feedback from all participants has encouraged us courage to plan for our next meeting in 2017. Everyone with interest in uro-oncology are invited!

ESU Course in Ukraine Ukraine urologists examine challenges in PCa treatment Prof. Aleksandr Shulyak Lviv Regional Clinical Hospital Dept. of Urology Lviv (UA) avshulyak@ yandex.ua Kiev hosted last June 18 to 20 the meeting of the Ukraine Urological Association (UUA) with the participation of the European School of Urology (ESU) and under the auspices of the UUA and the European Association of Urology (EAU).

The event had the support of the National Academy of Medical Sciences (NAMS) of Ukraine, the Ministry of Health of Ukraine, Institute of Urology of Ukraine and the National Medical Academy of Postgraduate Education P. Shupyk.

More than 500 urologists attended the meeting which tackled topics such as the early diagnosis of prostate cancer (PCa), treatment of locally advanced, castrate-resistant and metastatic prostate cancer, disease prevention, sexual rehabilitation of PCa patients, treatment of LUTS, an update on new methods of diagnosing and treating onco-urological diseases, endoscopy, laparoscopy and robot-assisted surgery.

At the June 18 opening day session, which also marked the 50th anniversary of the Institute of Urology of NAMS of Ukraine, Prof. Sergey Vozianov, head of NAMS, gave the opening remarks, highlighting the recent achievements of the institute and future challenges.

During the anniversary programme the institute officially recognized the leading scientists of the UUA and Institute of Urology of NAMS of Ukraine, the

Plenary session in Kiev

August/September 2015

country’s leading public institution in urology, sexology and andrology.

The institute’s 50-year history saw the leadership of some of Ukraine’s leading urology experts such as Prof. Yu Edynuy (1965-1968), P. Fedorchenko (19681969), and V. Karpenko (1969-1987). The institute has a staff of 524 employees, 14 professors, 20 doctors and 43 candidates of sciences, and with its 14 scientific departments the institute is renowned for its high-quality research. Among its well-known experts are Professors A. Romanenko, S. Vozianov, S. Pasechnikov, V.Sakalo, I. Gorpinchenko, V. Dzyurak, V. Chernenko, V. Pirogov, G. Drannik, A. Rudenko, N. Saydakova, G. Nikulina and V. Grigorenko.

Prof. A. Shulyak during the plenary session

ESU Course on prostate cancer Symposiums were held on the first day with discussions on LUTS, BPH, UTI and the treatment of prostatitis.

Van Der Poel also spoke about the benefits and challenges of robotic-assisted radical prostatectomy.

In his concluding remarks, he opined that despite the problems of robot-assisted radical prostatectomy, minimal invasive procedures point to the future of The plenary sessions tackled challenging case reports. urology. In another lecture, Van Der Poel discussed Prof. S. Pasechnikov discussed prostate tumours modern approaches to hormonal therapy for infection pathogens and sexually transmitted diseases advanced and metastatic PCa. He drew the attention while Prof. F. Kostev spoke on the epigenetic cancer of the audience to the benefits of intermittent screening tumours of the prostate. Prof. S. Vozianov hormone therapy and indications for continuous lectured on the modern principles of treating stress hormone therapy, the choice of drugs for hormonal urinary incontinence in men after prostatectomy. treatment and their shortcomings.

The next day programme featured the ESU’s course on prostate cancer. Prof. M. Babjuk (CZ) opened the session with an overview update on the educational opportunities offered by the EAU such as internships, fellowships and clinical visits. He then discussed one of the main topics, posing the question: Is surgery the treatment option for high-risk prostate cancer? Prof.

Babjuk examined the indications for surgery in this group of patients and the risk of late surgery.

Prof. H. Van Der Poel (NL) spoke about active surveillance in patients with localised prostate cancer, and underscored the challenge of a careful selection of patients for active surveillance and the optimal strategy for these patients.

Opening remarks by Prof. S. Vozianov

Prof. Babjuk also returned to the podium with a very interesting lecture on adjuvant and salvage treatment after radical prostatectomy. He highlighted the indications for adjuvant treatment after radical prostatectomy. He noted the technical problems in salvage treatment and the choice for this therapy remains debatable. Babjuk also discussed the treatment options for CRPC, prospective management options, and the purpose and principles of alternating drugs.

Case reports were presented by Bondarenko Yu including two clinical cases which prompted an enthusiastic response from the audience and a discussion with Professors Babjuk, Van Der Poel, A. Vozianov, E. Stachovsky and A. Shulyak.

ESU Course faculty members lecture on PCa management

at the Institute of Urology (Kiev). Below are the links: http://uro.tv http://uroweb.ru http://ukraine.uroweb.ru http://www.inurol.kiev.ua The lectures were translated simultaneously for the congress participants and Internet users. Online broadcasts were followed by over 150 urologists of Ukraine and CIS countries (Russia, Belarus, Kazakhstan, Armenia, Uzbekistan and other countries). We believe that easy access to education is important since it widens the interest for education and urology.

Prof. Udo Jonas (DE) delivered the ESU Guest lecture titled “An Overview of Modern Methods of Surgical Treatment in Urology,” discussing the latest methods of diagnosis and surgical treatment of urological diseases such as NBI, SPIES and others.

On June 20 the Museum of the Institute of Urology was also formally opened, which also marked the institute’s 50th Anniversary. The next UUA Congress will be on April 21 to 23, 2016 in Kiev.

For interested readers, the course materials were posted in the online portal uroweb.ru jointly organised by the Department of Regional Urology, Institute of Urology N. Lopatkin (head Shaderkin I.) European Urology Today

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ESU-Weill Cornell Masterclass 2015 Inspiring masterclass yields news insights on core urological topics Dr. Tigran Oganov Dept of Urology ARTMED Medical Center Yerevan (AM)

oganov@ hotmail.com First, I express my thanks to the American Austrian Foundation for the opportunity to participate at the ESU-Weill Cornell Masterclass in Urology held from July 5 to 10 this year in Salzburg, Austria.

My personal impressions about the meeting are definitely positive and not only with regards the scientific programme but also the way the arrangements and coordination were handled. There were several things that made my participation at the conference comfortable and easy. The excellent organisation included preparations such as visa and funding arrangements. The efficient arrangements enabled me to focus on the main goals of the master class which are direct communication with the expert faculty, a thorough discussion of current urology issues, dynamic interaction during the sessions and an active exchange of professional experience.

Salzburg Right on the first day I was acquainted with Salzburg.

The rococo architecture of the venue, Schloss Arenberg Castle, gave the right atmosphere to the master class. The Welcome Reception gave the participants the chance to introduce themselves before dinner. I was pleasantly surprised by the diversity of countries presented, which reminded me that one benefit of attending an international event is the chance to examine various viewpoints. Interesting acquaintances and a delicious dinner in a grand setting such as Schloss Arenberg made the atmosphere very enjoyable- and this was only the first day!

In-depth discussions The first session day showed the diversity of participants and many were from Eastern Europe.

Most participants from the region have a common challenge and that is the lack of multidisciplinary teams. Initially, the pre-seminar test seemed easy to me. However, I realised later on, after several lectures, that I made mistakes. The first lecture by Dr. Sandhu set the tone of the session. I should note that I value the interactive setting which allows equal opportunities to all participants to express their views, facilitating the learning process. The case reports by the participants were very useful in both theoretical and practical points of view. The faculty made insightful comments and the participants responded with their own perspectives. The informative talk by Prof. Palou and his handy tips on “How to prepare and deliver a good lecture,” helped me a lot in my own case presentation.

Later that day I visited the historic centre and the Fortress Hohensalzburg (literally “High Salzburg Fortress”) which has a magnificent view of Salzburg and the nearby mountains. The castle is famous Salzburg landmark, and there I was fortunate to experience a quartet playing classical music in the castle’s richly decorated hall.

On the third day I visited the city centre. Salzburg is closely linked with Mozart and the town centre did not disappoint me. I find it difficult not to associate Salzburg with Mozart as I walked the streets, with

Panoramic view of Salburg

From left: Prof . Aulitzky, Prof. Palou, Prof. Herr and Dr. Patrascoiu Sorin, with his Diploma of Academic Excellence (first place at evaluation test)

the music of Mozart’s symphonies humming in my head. Salzburg has the atmosphere to bring one back to a previous century, a nostalgic trip to a time when great music has the power to unlock human emotions.

Uro-oncology and laparoscopy training The session for the fourth day was dedicated to uro-oncology, my primary field of interest. I already had the chance to talk with Prof. Herr and Dr. M. Donat regarding current issues in uro-oncology. Their mentorship, expertise and knowledge were inspiring.

The insights I learned definitely made this segment of the programme one of the most remarkable.

Case presentation The Friday session focused on paediatric urology and I found the topics and discussions quite interesting although paediatric urology is not one of my direct interests. I also had to present my case and the worries I had about my presentation turned out to be baseless. During the presentation itself I felt more energised and confident. My fellow participants showed genuine interest in my presentation and I had the feeling that I have done my best.

My expectations of the masterclass were fulfilled and I find the whole programme very effective. The lectures and sessions were informative and the discussions yield new insights. The debates with the faculty over The Thursday programme was also important. In specific cases, the surgical tips and other practical particular the lecture on chemotherapy for bladder insights were valuable and inspiring. The last informal cancer will definitely improve my management of cancer gathering during the Farewell Dinner was memorable patients. Special thanks to the Olympus team for the and my phone number list grew longer with more hands-on laparoscopy training. Not only have I exercised new contacts and friends! Finally, I convey my thanks my skills but was also reminded of the growing to our local coordinator Dr. Bella Grigoryan, whose importance of the role of high technology in medicine. assistance made my participation possible.

A memorable training in Salzburg Mozart’s birth city impresses Ukraine doctor Dr. Viktor Chaikovskyi Dept of Urology Dnipropetrovsk City Multifield Clinical Hospital Dnipropetrovsky (UA)

witamin@ukr.net On the narrow quiet street of Arenbergstrasse, located at the foot of the mountain Kapuzinerberg, is the five-storey 19th century Schloss Arenberg, the venue of and our residence for the ESU-Weill Cornell Masterclass.

In same evening after our arrival we met the faculty members, a memorable experience as we are meeting international experts whom we have only read about, and an inspiration for many young doctors. Professors Harry Herr and Joan Palou welcomed us and raised a toast to a productive meeting.

The lecture hall on the third floor was a large bright room with decorated wood, a beautiful carved ceiling, wood-panelled walls and parquet flooring. The lectures were held from Monday to Friday with topics such as urodynamics, bladder cancer, reconstructive urology, urothelial carcinoma and paediatric urology. All issues were discussed in great detail and a lot of time was allotted for discussion, which one does not often experience in conventional meetings.

Personally, I wish the masterclass addressed the issues of prostate and renal cancers, and the segment on paediatric urology could be taught in a module for paediatric surgeons. But most probably five days wouldn’t have been enough. Prof. Palou

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European Urology Today

"Prof. Palou gave very helpful tips on presentation skills..."

Session lectures

gave very helpful tips on presentation skills, and for three days every participant had the opportunity to present an interesting clinical case from his practice for discussion and detailed assessment. This gave us a very valuable experience and training in presentation.

The five days passed quickly. A gala dinner was held together with the presentation of certificates, and after the ceremony one realises that a memorable training has ended. I would like to express my gratitude to the teachers, organizers and sponsors for a meaningful experience in the theory and practice of urology, and also for the wonderful chance to be acquainted with the fascinating city of Salzburg.

In two days, three hours each day were allocated for hands-on-training and there were many participants compared to the number of simulators. There were two simulators for transurethral resections, two simulators for endoscopic surgery on the upper urinary tract and only one simulator for laparoscopy.

I think that for laparoscopy there has to be at least three simulators. For transurethral operations, one is enough, since this is a fairly routine type of operation and for many the procedure has already been studied and put into practice.

The masterclass gathered 36 participants coming mainly from Eastern Europe and the former Soviet republics, with one or two participants representing each country. The fellows have various backgrounds based on their training, work conditions and opportunities. It was a very interesting mix, a small number of participants coming from a vast geographical area which can lead to a dynamic exchange of experience and information.

Schloss Arenberg has the features of a grand and aristocratic villa. It has marble floors and massive columns like in a medieval castle. The guest

the architecture on the main square in the Old Town such as Rezidentsplyats and Fortress Hohensalzburg are among the city’s iconic symbols. I visited the street Getreidegasse, where in House No. 9 Wolfgang Amadeus Mozart was born. I enjoyed the memorable lawns, fountains and park sculptures in Mirabellgarten, certainly a garden worthy of a visit.

rooms are very comfortable with minimalist design. The windows of the upper floors offer fantastic views of the Alps. Fresh air and the sound of bird song and rustling leaves are ideal conditions for a good rest and sleep after long hours of lectures.

Improving operating skills on the Olympus simulators

Despite the hectic schedule there was enough time to explore Salzburg and discover its attractions. Salzburg is a phenomenal city and

Preparing for the case report presentations

August/September 2015

Initiatives amid challenges in functional urology Functional urology requires more talent, closer integration and streamlined training Functional urology, as one of urology’s core specialities, is a dynamic field replete with challenges but the specialty requires wellcoordinated and sustained efforts by way of training, education and proper integration with other medical disciplines to maintain its frontline role in offering optimal patient care.

Section of Female and Functional Urology (ESSFU) of which Heesakkers serves as chairman, Heesakkers assessed the achievements of the masterclass.

Prof. John Heesakkers

“There are many technological challenges in functional urology. Since we know our capabilities, the potential drawbacks and why things fail, we can also define what is needed and what our targets are to improve our activities. Functional urology should be in the driver's seat and provide direction to health authorities in identifying priorities and development goals that are most likely to succeed,” said Prof. John Heesakkers (NL).

Heesakkers, together with Prof. Dirk De Ridder, is one of two course directors of the annual ESU Masterclass on Female and Functional Reconstructive Urology, which is now on its eight year in offering a compact and

comprehensive masterclass to mid-career urologists interested to refine their skills and knowledge.

To be held in Berlin from November 26 to 28, the three-day programme does not only provide direct interaction with functional urology experts from across Europe, but also serves as a recruitment pool for talented urologists looking for follow-up training and fellowships in expert centres.

Nearing its first decade and co-organised by the European School of Urology (ESU) and the EAU

High scores for Salzburg Dr. Ilya Zelenkevich, Belarus National Cancer Centre, Minsk (BY) I am thankful to the organisers, lecturers and participants of the ESU-Weill Master Class for a truly fascinating professional and personal experience. We did not only share our experience but also had the opportunity to hear lectures and discussed with expert urologists of the world. Besides the intensive five days of sessions, there was also a hands-on laparoscopic training. Salzburg is also a very cosy and welcoming city.

Dr. Patrascoiu Sorin, Chief, Urology Department, St. Mary Clinical Hospital, Bucharest (RO) The masterclass was a memorable urology week in a memorable place with memorable people. Besides the outstanding faculty, we had the great opportunity to create professional relationships in a unique place – Salzburg. I also appreciated the social programme which gave us the chance to meet the expert faculty in a more friendly setting.

Both the American and European faculties impressed me and course directors Professors Herr and Palou were not only very open but were also very active debaters during the sessions. Undoubtedly, the ESU-Weill Cornell Masterclass is an effective, successful meeting. I am fortunate to be part of this wonderful event.

Dr. Kliment Bonev, Lincoln County Hospital, Lincoln (UK/BG) This masterclass gave me the chance to meet well-known urologists like Professors Harry Herr, Donat, Palou, Poppas and Tekgul, among others. They discussed contemporary urology news and questions on management, diagnosis and treatment. Aside from lectures, we also had case-based sessions with case reports presented by fellow participants from Central and Eastern Europe and Asia. Various diagnostic and therapeutic approaches were discussed, providing insights on clinical practices. The scientific programme was balanced by an excellent social and cultural programme. Participants were treated to a concert by top musicians who played the music of Wolfgang Amadeus Mozart in his own birthplace-Salzburg! I also visited museums and the city’s popular sights. This well-organised masterclass was a lovely week full of science, new friendships and remarkable social events that convinced to again visit the city of Mozart.

Dr. Boris Mladenov, University Hospital Pirogov (BG) A very important benefit for me was the opportunity of exchanging experiences and ideas with colleagues from various countries, and this was made possible not only through the social programme, but also through the case presentations. Apart from learning new things, it contributed to developing soft skills such as in presentation. This course not only motivated me to further boost my knowledge, but also to share it with others in my home country to multiply the effect, one of the main goals of the programme.

“We have succeeded in putting functional urology on the map. But we also know there is a growing need for well-trained functional urologists in Europe and we also know that there is a demand from potential functional urologists for high-level training,” said Heesakkers. “By far, we have come up with a balanced programme where participants can have in-depth discussions with a skilled faculty offering practical and scientific viewpoints, as well as learning from theoretical and practical cases.”

Expanded reach Despite the success of the masterclass, Heesakkers conceded there is a need to widen its reach and continue with the goal in encouraging urologists who are keen to specialise in functional urology.

“We still need to promote the Masterclass so that more European urologists will know about its goals.

Second, we should boost our efforts to increasingly standardise our way of working,” said Heesakkers.

He cited the EAU Guidelines as a example on how to boost the influence and role of functional urology specialists.

need to know who we should serve and what the service should focus on. Finally, we should go back to our patients, ask them how we can provide better care,” according to Heesakkers.

"...there is a growing need for well-trained functional urologists in Europe and a demand from potential functional urologists for high-level training..."

Although other urological fields such as urooncology are often in the public attention, Heesakkers believes that specialising in functional urology has its own unique challenges and will thrive in the years to come.

“With the diversification and supraspecialisation more urologists will follow a focused path in functional urology (FU) once they start their training. Functional urology has more to offer with respect to diagnostics and treatment,’’ he said. “In our field there is more individualized care for oncological and neurological patients which implies more attention on the functional sequel of treatment. Integration (with other medical disciplines) also means that this has to be taken into account and attended to.”

“The Guidelines is a good example and we need more such initiatives. From a practical point of view we have to document what we are doing in a consolidated manner, and show objectively how good we are as functional urologists with our treatments,” he said while noting that internationally-organised registries and studies are the way to go.

The Masterclass has a full programme that includes the management of functional disorders in female patients such as lower urinary tract diseases and those in the pelvic floor and related organs, male incontinence, neurogenic bladder, reconstructive urology and diversion surgery, among other issues.

“We also need to get in touch with our younger and potential colleagues and ask them what their needs are on how to start a successful practice. We really

For details on registration and the Scientific Programme, visit the meeting website at: www.esufemale15.org

www.esufemale15.org

8th ESU Masterclass on Female and functional reconstructive urology In collaboration with the EAU Section of Female and Functional Urology (ESFFU)

26-28 November 2015, Berlin, Germany EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations

Dr. Victor Madan, Central University Military Hospital, University of Medicine and Pharmacology, Bucharest (RO) The masterclass had very interesting topics led by a sharp-minded faculty and held in the beautiful Schloss Arenberg in Salzburg – the ingredients for one of my best learning experiences. Case presentations and discussion, close interaction with the faculty members and a lot of new friends inspire me to recommend this event to my colleagues. Many thanks to the American Austrian Foundation and European School of Urology! I will definitely come back if I will have the opportunity!

Dr. Osama Al-Alao, Hamad Medical Corporation (QA) Good times passed quickly! The week I spent in Salzburg was so good and it ended in a blink of an eye. I'm really grateful for the amazing efforts spent for this educational programme. The faculty members provided a good example of dedication. Thanks Salzburg for an amazing experience!

Dr. Fadi Dalati, Université Libre de Bruxelles, Brussels (BE) Meeting pioneers in our field, getting to know urologists from all over the world, sharing ideas and cases among colleagues—the masterclass was a great experience that I will remember and cherish for a long time.

Application deadline 1 October 2015

Dr. Marjan Maric, University Hospital Zagreb, Zagreb (HR) I had a wonderful time conversing with my fellow participants and with the faculty members who were all top experts in their respective fields. I hope to join this event again in the future.

August/September 2015

European Urology Today

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Teaching activities 2015

www.esusalzburg16.org

European School of Urology September 4-9 15 18

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13th European Urology Residents Education Programme (EUREP), Prague (CZ) ESU-ERUS courses at the 12th Meeting of the EAU Robotic Urology Section (ERUS), Bilbao (ES) ESU course on Management of the lower urinary tract with benign urological problems at the national congress of the Polish Urological Association, Warsaw (PL) ESU course on What’s new in male infertility and (locally) advanced prostate cancer at the national congress of the Russian Society of Urology, St. Petersburg (RU)

October 4

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ESU course on Hot topics in urogenital infections at the time of the EAU 15th Central European Meeting, Budapest (HU) ESU course on Urinary infections at the national congress of the Czech Urological Society, Olomouc (CZ) ESU course on Paediatric urology for the adult urologist: A practical update, at the national congress of Tunisian Urological Society, Sousse (TN) ESU course on Any progress in prostate and kidney cancer treatment? And Update on modern stone treatment at the national congress of the Moldavian Urological Society, Chisinau (MD)

ESU - Weill Cornell Masterclass in General urology 26 June-2 July 2016, Salzburg, Austria EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations

November 2

4-5

7 7

10-14

12

26-28

ESU course on Male LUTS, urinary incontinence and fistula at the national congress of the Scientific Society of Urologists of Uzbekistan, Tashkent (UZ) 2nd ESU Masterclass on Lasers in urology, in collaboration with the EAU Section of Uro-Technology (ESUT), Barcelona (ES) ESU course at the time of the EAU 11th South Eastern European Meeting, Antalya (TR) ESU course on Bladder cancer at the biannual congress of the Urological Association of Northern Greece, Thessaloniki (GR) 2nd Confederación Americana de Urologia Residents Education Programme (CAUREP), Cancun (MX) ESU courses on Medical treatment of metastatic renal cancer and Castrate resistant prostate cancer at the occasion of the 7th European Multidisciplinary Meeting in Urological Cancers (EMUC), Barcelona (ES) 8th ESU Masterclass on Female and functional reconstructive urology, in collaboration with the EAU Section of Female and Functional Urology (ESFFU), Berlin (DE)

December 2

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ESU course on Endourology at the national congress of the Egyptian Association of Urology, Cairo (EG) ESU course on Prostate and bladder cancer at the national congress of the Georgian Association of Urology, Batumi (GE)

Contact: esu@uroweb.org

www.esulasers15.org

www.esudavos16.org

2nd ESU Masterclass on Lasers in urology

European Urology Forum 2016 25th

In collaboration with the EAU Section of Technology (ESUT)

Challenge the experts

4-5 November 2015, Barcelona, Spain

Anniversary

13-16 February 2016, Davos, Switzerland EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations

EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations

Application deadline 1 September 2015

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European Urology Today

August/September 2015

E-BLUS looks beyond Europe in 2015 EAU’s standardised basic laparoscopy training programme gains worldwide popularity Dr. Ali Serdar Gözen ESU/ESUT Training & Research Group member SLK-Kliniken Dept. of Urology Heilbronn (DE) asgozen@yahoo.com The first European Training in Basic Laparoscopic Urological Skills (E-BLUS) was organised for final-year European residents in 2011, during the 9th European Urology Residents Education Programme (EUREP) in Prague.

The European School of Urology and EAU Section for Uro-Technology (ESUT) designed the programme to standardise basic laparoscopic training in Europe. The course continued to be offered at annual EAU congresses and EUREP.

knowledge is easy to understand and the level of the trainees can be checked with the online exam before starting with the hands-on training part.

Our aim as ESU/ESUT Training & Research Group is to standardise and improve the training programmes in all aspects. I think these contacts will provide us with more innovation and give us the courage to develop and share the next steps of our laparoscopy training programme.

The interest was very high and EAU decided to also offer this first-rate programme to urologists worldwide. The ESU/ESUT Training & Research Group has led the organisation, hand-in-hand with the EAU’s central office, which supported this project with top priority.

This optimal teamwork paid off: in 2015, E-BLUS is part of 24 national and international congresses and laparoscopy courses. In this way, trainees get the chance to be able to work with experienced international tutors and take a one-to-one training course with personal training advice at the end. The ESU/ESUT Training & Research Group members briefed the local tutors and supervised the quality of the conducted exam and the maintenance of suitable standards on behalf of the EAU. The E-BLUS exam, which is an integral part of E-BLUS, became the next complementary element of teaching system and the exam has been offered in all suitable centres. The trainees have taken E-BLUS exam and trained hard for this unique certificate which is the only one on the world to be awarded following a strict, formal exam.

Upcoming E-BLUS Events

One-on-one guidance for trainees in Bydgoszcz

With this programme, the EAU has improved laparoscopic skills across the world, from Jakarta in the East, Vladivostok in the North, London in the West and Khartoum in the South. This is a result of the EAU’s three-continent Education & Cooperation effort.

In addition to a laparoscopy training programme, E-BLUS has also shown to be a scientific way to keep in touch with urologists worldwide. Sharing the knowledge and experience with all the colleagues and friends was also a unique experience for us. I am sure that we will improve this project in the next years and will reach more and more urologists in all directions.

3-9 September 2015, Czech Republic (Prague) 13th EUREP 8-10 September 2015, Russia (Vladivostok) International Laparoscopy Applied Course (ESUT) 24-26 September 2015, Romania (Cluj) 4th Laparoscopic Urology Course CLERU (ESUT) 24-27 September 2015, Portugal (Braga) Portuguese Association of Urology Congress 1-4 October 2015, United Kingdom (London) 33rd World Congress of Endourology and SWL (WCE 2015) 2-4 October 2015, Hungary (Budapest) EAU 15th Central European Meeting 20-22 October 2015, Turkey (Izmir) Annual Turkish Urology Congress 23-24 October 2015, Turkey (Izmir) World Videourology Congress (ESUT)

Laparoscopy workshop in St. Luke's Hospital in Bydgoszcz, Poland, 13-14 April 2015

3-6 November 2015, Jordan (Amman) 12th Annual Congress of the Arab Association of Urology

The E-BLUS programme includes an online theoretical laparoscopy course and a four-step Hands-on training (HOT) session. These basic skills are then tested after the training in a validated exam. After the success of several pilot courses at various national congresses, the E-BLUS rapidly gained attention from young urologists and particularly residents in training.

These first very positive impressions have demonstrated the need for such a complete basic laparoscopy training programme which includes a theoretical part as well as a solid training part. The online theoretical part with basic laparoscopic

6-8 November 2015, Turkey (Antalya) EAU 11th South Eastern European Meeting (SEEM) (ESUT) 30 November – 4 December 2015, Egypt (Cairo) 50th Egyptian Urological Association (EUA) congress (ESUT) 11-15 March 2016, Germany (Munich) 31st Annual EAU Congress Urooncology Symposium of the Indonesian Urology Association in Jakarta, 29 April - 2 May, 2015

European Urology Today - Manuscript Submission European Urology Today, the EAU newsletter is published five times each year. Its main role is to function as the European Association of Urology’s bulletin, as a platform for the EAU to present their meetings, the various sections and offices, as well as discuss general issues of interest to their members. Another important objective is to have a platform that allows for the inclusion of a range of scientific papers which are considered of interest to a large readership.

Editorial Policy Manuscripts are submitted with the explicit understanding that the decision to include material will be made by the Editor-in-Chief in conjunction with his Section Editors. All authors have read and approved the manuscript subject to submission. It is the author’s responsibility to obtain permission to reproduce any parts of other publications (i.e., tables, figures). Precise reference to the original work must be given in the legends.

Statements in articles or opinions expressed by any contributor in any article are not the responsibility of the editors or the publisher. The publisher is not responsible for the loss of manuscripts through circumstances beyond their control.

The publisher will commit itself to make judicious use of the article in accordance with the aims and objectives of the association and make the article available to medical professionals at no cost.

August/September 2015

Manuscript Submission Manuscripts and questions regarding manuscript submission may be directed to: European Association of Urology European Urology Today Editorial Office P.O. Box 30016 6803 AA Arnhem, The Netherlands Telephone: +31 (0)26 389 0680 E-mail: EUT@uroweb.org Submission of an article signifies the author’s consent to transfer copyright to the EAU, publisher of European Urology Today.

All authors are kindly requested to submit a photograph of themselves (and their co-authors).

Case Submission Interesting and challenging cases are published and discussed in the Clinical Challenge section.

Please submit your case for consideration to the EUT Editorial Office.

Submission platforms All material is to be submitted in English, as Word file, TXT files for text and JPG, TIFF, PPT for illustrations. All illustrations must be a minimum of 300 dpi to meet printing quality.

For files over 10 MB WeTransfer can be used.

Word count for authors is available on request at the EUT Editorial Office.

Proofs

Young Urologists/Residents Corner

Accepted manuscripts will be copy-edited to bring them into conformity with the journal’s style.

Unless otherwise indicated, proofs are sent in PDF format via e-mail to the corresponding author.

Proofs must be returned within the deadline specified by the publisher.

This section is reserved for articles of which the first author is a resident in training.

All material is to be submitted for consideration to the Section Editor responsible for this section, Dr. S. Sarikaya, drselcuksarikaya@hotmail.com

Types of Articles Original articles Original articles may be solicited by the editorial board or submitted to the editorial board for consideration. In case of doubt, authors are encouraged to check with the editorial board describing the content of their article before submission. Maximum word count for original articles is approximately 1,800 words, exclusive of references and illustrations.

In case authors provide large reference files, the Editor-in-Chief may decide to either limit the total number of references included in the print, or make references available on request through EUT@uroweb.org.

Effects and Actions: Meeting Reports Maximum word count for submitted articles is approximately 1,000, exclusive of illustrations.

Only reports of EAU related meetings accompanied by high resolution photos will be published. All material is to be submitted initially to the EUT Editorial Office, EUT@uroweb.org

Reports (General - Accredited/ Certified Centres – etc) General reports and papers on interesting developments/urology departments/accreditation etc. may be submitted for consideration to the Editor-in-Chief. Illustrations are welcome. Word count for reports are approximately 900/1,000 words.

Reviews of books, journals and new media Books, journals and new media to be considered for review may be sent to the EUT Editorial Office.

Letters to the editor Authors are welcome to submit letters to the editor. The text of letters should be limited to 500 words.

Letters to the editor will be published as space permits.

Information All queries on manuscript submission should be directed to the EUT Editorial Office at EUT@uroweb.org.

European Urology Today

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With the goal to encourage innovative, high-quality research in prostate cancer, the EAU has launched the EAU Prostate Cancer Research Award. Supported by an unrestricted educational grant from the Fritz H. Schröder Foundation, an expert jury will select the best paper dealing with clinical or experimental studies in prostate cancer and published or accepted by a renowned international scientific journal.

The award will be handed over at the 31st Annual EAU Congress in Munich, 11-15 March 2016 during the Opening Ceremony.

A review committee will screen all entries and an independent jury will select the best paper based on quality and merits.

How to apply Inquiries and correspondence should be addressed to the EAU Central Office, at m.smink@uroweb.org, with “EAU Prostate Cancer Research Award 2016” in the subject line of your e-mail.

The award is supported by an unrestricted educational grant of € 5,000 from the FRITZ H. SCHRÖDER FOUNDATION. www.fhsfoundation.eu

Join this competitive search and help boost the quality of prostate cancer research in Europe!

ly p Ap ow! n

EAU Prostate Cancer Research Award 2016

EAU Best Papers published in Urological Literature Awards To be awarded at the 31st Annual EAU Congress in Munich, 11-15 March 2016

ly p Ap ow! n

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European Urology Today

Rules and Eligibility • The topic of the paper should deal with clinical or experimental prostate cancer research.

• The paper must have been published or accepted for publication in a highranking international journal between 1 July 2014 and 30 June 2015, and submitted in the English language.

• Applicants must be a member of the EAU. • The submitting author must be the first author of the paper or, by exception, the corresponding senior last author.

• Applicants should only submit one paper.

• Deadline for submission by e-mail is 1 November 2015.

The two EAU Prizes for Best Paper published in Urological Literature are tools through which the EAU encourages young and promising urological scientists to continue their work and to communicate their achievements to the European urological community.

Two awards of € 5,000 each will be made available for the two Best Papers published in Urological Literature on Clinical and Fundamental Research. These papers have to be published or accepted for publication between 1 July 2014 and 30 June 2015.

The awards will be handed out at the 31st Annual EAU Congress in Munich, 11-15 March 2016.

Rules and Eligibility • Eligible to apply for the EAU Best Paper published in Urological Literature are urologists, urologists-in-training or urology-related scientists. All applicants have to be a member of the EAU. • The submitting author must be either the first or the corresponding senior last author.

• Each author is allowed to submit no more than one paper.

• The paper must be written in the English language (or translated into the English language).

• The subject of the paper must be urological or urology related.

• The deadline for submission is 1 November 2015.

How to apply • Please send your paper by e-mail to m.smink@uroweb.org, indicating clearly the category in the subject line: “EAU Best Paper on Clinical Research” or “EAU Best Paper on Fundamental Research”.

• Include a copy of your curriculum vitae.

• Supply a list of all authors who have significantly contributed (if relevant).

• Mention any financial support by companies, government or health organisations.

• A publisher’s letter of acceptance has to be submitted along with your paper.

A review committee consisting of members of the EAU Scientific Congress Office will review all submitted papers and select the winner of the two EAU awards for Best Paper published in Urological Literature.

August/September 2015

The EAU Hans Marberger Award 2016 will be handed out for the best European paper published on Minimally Invasive Surgery in Urology. The award, annually given since 2004, is named after Prof. Hans Marberger to honour his pioneering achievements and contributions to endourology and the development of urologic minimally invasive surgical procedures.

How to apply Please send your paper to the EAU Central Office at m.smink@uroweb.org and mention “EAU Hans Marberger Award 2016” in the subject line of your e-mail.

The award will be handed over at the 31st Annual EAU Congress in Munich, 11-15 March 2016 during the Opening Ceremony.

The EAU Hans Marberger Award is supported by an unrestricted educational grant of h 5,000 from KARL STORZ GMBH & CO.KG.

Rules and Eligibility • All urologists and scientists are invited to send in papers.

• The topic of the paper should deal with Minimally Invasive Surgery in Urology.

• The paper must have been published or accepted for publication in a European Journal between 1 July 2014 and 30 June 2015.

• All papers must be submitted in the English language.

• All applicants have to be a member of the EAU. • The submitting author must be either the first or the corresponding senior last author.

• Each author is allowed to submit no more than one paper.

• Deadline for submission is 1 November 2015.

Win the EAU Hans Marberger Award 2016 Submit your paper on Minimally Invasive Surgery and you might be awarded the EAU Hans Marberger Award 2016 of € 5,000!

The EAU Crystal Matula Award 2016 is the most prestigious prize given to a young promising European urologist under the age of 40 who has the potential to become one of the future leaders in academic European urology. The award will be presented at the Opening Ceremony of the upcoming 31st Annual EAU Congress in Munich, Germany from 11 to 15 March 2016.

The list of previous awardees includes many well-known names: M. Rouprêt (2015), S.F. Shariat (2014), P. Boström (2013), P.J. Bastian (2012), S.G. Joniau (2011), J.W.F. Catto (2010), M.J. Ribal (2009), V. Ficarra (2008), M.S. Michel (2007), A. De La Taille (2006), M.P. Matikainen (2005), P.F.A. Mulders (2004), B. Malavaud (2003), M. Kuczyk (2002), B. Djavan (2001), A. Zlotta (2000), G. Thalmann (1999), F. Montorsi (1998), F.C. Hamdy (1996).

EAU Crystal Matula Award 2016

ur s o d y tion n Se ina y! m a no tod

August/September 2015

A review committee, consisting of members of the EAU Scientific Congress Office, will select the winning paper.

Nomination process National Societies can nominate a candidate by supplying the following documents: • letter of endorsement • motivation letter • complete curriculum vitae • list of publications in the below sequence: 1. Peer reviewed papers (including the impact factors of the journals) • original articles • reviews • case reports

2. Book chapters or editor of books • overview of grants received from (inter-)national institutions or from the industry • list of received Awards • The deadline for nomination is 1 November 2015 Please note that eligible candidates can also apply for this award by contacting their national urological societies directly.

The candidate is then expected to supply his/her national society with a CV and the above mentioned documents, requesting a letter of endorsement.

How to apply Please send your nominations to the EAU Central Office at m.smink@uroweb.org and mention “EAU Crystal Matula Award 2016” in the subject line of your e-mail.

The EAU Crystal Matula Award is supported by an unrestricted educational grant of h 10,000 from LABORIE. LABORIE

European Urology Today

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Young Urologists/Residents Corner Paediatric urology training in Istanbul Intensive surgical training at Bezmialem University Hospital Dr. Teele Kuusk ESRU NCO Estonia Tartu University Tartu (ES)

Teele.kuusk@ gmail.com My visit to Bezmialem University Hospital in Istanbul was part of my urology training at the Tartu University of Estonia which included paediatric surgery training. The Bezmialem University Hospital is a high-quality clinic with an innovative research center and is known for its dedicated international staff of urologists.

clinic is one of the few European centres where pyeloplasty in children is done laparoscopically. They also have a considerable experience in endoscopic treatment of stone disease in children. The operations were performed quickly and elegantly.

I would like to note the outstanding tutorial skills of Prof. Silay who actively engages the residents in clinical work. He uses case reports to explain the theoretical part which made learning efficient and enjoyable. Despite the very busy outpatient clinic work where he normally sees 20 to 45 patients in eight hours, three times a week, he still has the energy to discuss with us the various cases.

Bezmialem Hospital’s Urology Department is also very active in organising courses. Within one month, I had the chance to attend the Stone Institute Hands-on Lab and Didactic Workshop in collaboration with the John Hopkins Medical Institute and also a course on complications of circumcision.

Organising the visit was facilitated by my mentor Assoc. Prof. Mesrur S. Silay and Sevsen Bati, head of the University International Relations Office. From the Besides the theoretical training, I also earned very first day I experienced warm hospitality. Each day valuable practical experience since during my free begins with a lovely Turkish breakfast and tea with time from paediatric urology I was invited to attend colleagues before we start our duties.

A regular working day would start at 7.30 or 8 o'clock, depending on the meeting schedule. Twice a week there were operating days when I could assist in operations including laparoscopic pyeloplasty, laparoscopic nephrectomy, TIP, extra- and intravesical uretheroneocystostomy, orhidopexy, circumcision, endoscopic stenting, uretereroscopy, RIRS, PCNL, cystostomy and meatatomy, among many other procedures. During the days for surgery we spend the whole day at the operating theatre from 8.30 until noon. Usually there were five to six operations. The

Laparoscopic pyeloplasty performed by Assoc. Prof. M.S. Silay

means that at the end of their residency they have at least a couple of published articles.

Colleagues from left to right: Dr. M.Akçay, Ass.Prof. A. Tepeler, Prof. A. Armagan, Dr. T. Kuusk, Assoc. Prof. M.S. Silay, Dr. I. Basibuyuk, Dr. F. Elbir, Dr. S. Kardas, Dr. M. Tosun.

operations by other urologists. They were not only very fluent in English which made communication very easy but also very friendly. I also realised how important it is for a doctor to get training in a highly populated country. The experience and caseloads are huge compared to doctors working in countries with a lower population density.

In the evenings and weekends I had the chance to experience the cultural events in this very busy metropolis of 14 million people. A month is certainly too short time to get acquainted with Istanbul, but I was happy to have fantastic colleagues who introduced me to Turkey’s rich cultural traditions and also showed me some lovely local places unknown to many tourists.

I am very thankful to my Estonian urology residency mentor, Dr. Kotsar, who supported my stay at Bezmialem and to all the staff urologists, especially my tutor Prof. Silay, and the residents at Bezmialem University Hospital who all made my stay very memorable.

Even during the short training, I had the opportunity to see rare children’s' urological diseases that otherwise I would have never seen. Moreover, the training of their residents is practical and after five years of residency they reach a certain level of skill, and which can only be through hard work and long days in the hospital.

A resident’s working day starts at 7 o'clock up to around 7 p.m. Right from the start of their training they are already on duty. They work for one month at the operating theatre where they operate under the guidance of a senior urologist supervisor. They are also assigned to work at the Outpatient Clinic. Usually the residents are also involved in research, which

Course on Complications in Circumcision: Assoc. Prof. M.S. Silay and Prof. A. Tasçi

80th Congress of the Spanish Urological Association Salamanca congress coincides with 1st AEU Residents and Young Urologist Workgroup Meeting Dr. Leonardo Tortolero Scientific Activities Manager Spanish Residents and Young Urologist Workgroup Vigo (ES) leotor85@gmail.com

Dr. Moises Rodriguez Urology resident Vigo (ES)

moisessocarras@ hotmail.com The 80th Spanish Annual Urology Congress held in Salamanca from June 10 to 13 and organised by the Asociación Española de Urología (AEU) was deemed a success based on the responses from participants and the extensive scope of the scientific programme.

All our expectations of the four-day event were surpassed with the highly dynamic sessions and enthusiastic inputs from all participants. About a thousand urologists and urology trainees from Spain, Argentina, Portugal, Mexico, Great Britain and Belgium attended the meeting. A total of 498 abstracts, 279 posters, 110 videos and 109 oral presentations were accepted, covering topics such as oncology, andrology, endourology, kidney stones, basic sciences, urology history and others.

The programme was of high quality and the wonderful plenary sessions were led by international expert speakers such as Professors Mark Emberton (UK) and Rafael Sanchez Salas (FR). Prof. Jesus Cisneros (ES) chaired the plenary session with these two renowned speakers which focused on new trends 24

European Urology Today

in focal therapy and advances in prostate cancer treatment. Prof. Antonio Alcaraz (ES), an expert in renal surgery, chaired an interesting session regarding the limits of partial nephrectomy.

Training courses directed by AEU and EAU Spanish experts were held during the congress with state-ofthe-art lectures, clinical and surgical skills and debates on prostate cancer, bladder cancer, renal cancer, laparoscopy, lymphadenectomy in urological tumours, RIRS, nephroscopy, laparoscopic retroperitoneal approaches, to name a few.

New workgroup Residents and young urologists in Spain have accepted the challenge of creating a new workgroup with the support of ESRU and YOU. During the congress they had the 1st Workgroup Meeting, which was received with great enthusiasm by AEU chairman Prof. Jose Manuel Cozar, treasurer Prof. Manuel Esteban and the rest of the AEU Board.

Dr. Juan Gómez Rivas, ESRU Internal Coordinator and Chairman of the Spanish Residents and Young Urologist Workgroup (RAEU), chaired the meeting. He was joined by Dr. Mario Alvarez-Maestro (Board Member-Endourology & Minimally Invasive Surgery Group of the Young Academic Urologists of the European Association of Urology), who encouraged the initiative and urged the organisers to look into the examples of well-established residents and young urologist groups such as the YAU and ESRU.

The RAEU’s board members were elected during the meeting and a brainstorming session identified many projects and ideas. We were also inspired by the survey results presented by ESRU Chairman Giulio Patruno during the EAU Annual Congress in Madrid regarding urological training in Europe. In response we have initiated a national survey on the current state of urology training in Spain to identify challenges and employment opportunities for young urologists. We expect to have the results soon for

presentation at the 2016 Spanish Urology Congress which will take place in Toledo.

Finally, we want to highlight the responsible use of social media (Twitter, Facebook, Linkedln and others) to facilitate communication and networking that may contribute in effectively connecting residents and young urologists. Visit our Facebook page Residentes AEU, follow us on Twitter: @ResidentesAEU, or take a look at our webpage: residentes.aeu.es for more information.

Activities ESRU Turkey, September 2015 As ESRU Turkey team, we are organising an online webinar about ‘How to write a manuscript?’ in collaboration with ManuscriptEdit team and with the support of ESRU. The course programme will be in English, free to join and open for all European residents.

A Basic Urodynamics Course and Functional Urology Symposium is also planned in September 2015, Ankara, Turkey.

The course and symposium programme will be in English, free for all residents and open for all European residents.

Dr. Selçuk Sarikaya Chairman of ESRU Turkey, Chairman-Elect of ESRU, Ankara (TR) RAEU and AEU Board Members

August/September 2015

Young Urologists/Residents Corner ESRU.be Day Challenging the guidelines Dr. Barbara Hermans Resident Urology Membership, ESRU Belgium UZ Leuven Leuven (BE) barbarahermans@ hotmail.com

Dr. Jeroen Van Besien Resident Urology Membership, ESRU Belgium Ghent University Hospital Ghent (BE) jeroen.vanbesien@ ugent.be The ESRU.be Day is an annual scientific and social event organised by the Belgian section of the ESRU. It has traditionally been the responsibility of the chairman-elect to organise this event as a final test before he becomes the new chairman.

Dr. Vincent De Coninck, a last year resident at UZ Brussels, is the new Belgian chairman of the ESRU and has organised this year’s ESRU Day and made it a real challenge to the guidelines.

The Belgian ESRU.be Day, where all Belgian urology residents and urologists are invited, presents a series of scientific lectures by experts and a social programme. This year the venue was at a renovated

farmstead in Grimbergen (close to Brussels). The ESRU board chose ‘Challenging the Guidelines’ as this year’s theme. Six experts examined specific topics in the 2015 EAU guidelines followed by a critique by participants and the audience.

Scientific programme The programme opened with remarks from the past chairman, Dr. Pieter Uvin, who assessed the group’s activities in the last year and gave a glimpse of future projects. He thanked the ESRU Board and introduced the incoming board while stressing the importance of further boosting the support for ESRU.

challenged the guidelines regarding antibiotic prophylaxis in endo–urology. He stressed that it is vital to prevent urinary sepsis and not bacteriuria. Prevention during urological procedures has changed over the last decade and this evolution has partially been driven by industry. The number needed to treat with antibiotic prophylaxis to prevent a case of urinary infection is quite high. Considering the widespread use of these antibiotics there are also financial considerations when prescribing these drugs. There are some strict indications, however, where prophylactic antibiotics are not to be omitted such as a bacteriuria prior to a transurethral prostate resection or a single-shot antibiotic prophylaxis before upper urinary tract surgery.

Dr. A-F Spinoit (University Hospital Ghent) discussed endoscopic versus non-endoscopic treatment of "Despite the fact that HOLEP is a vesicoureteral reflux. Cases that used to be a true first choice for obstructive voiding contra-indication, such as a duplicated system, can be treated endoscopically nowadays. She stressed the symptoms (according to the 2015 difference between high- and low risk reflux with the EAU Guidelines) its use is still not latter mostly treated conservatively. Spinoit challenged the audience by presenting various case reports, and widespread in Belgium." after the discussions it was the opinion of many that a treatment decision is not always as straightforward as Prof. Dr. D. Michielsen (University Hospital Brussels) one would think. provided insights with regards intravesical instillation therapy for bladder cancer. He briefly reviewed the Prof. Dr. J-M De Meyer (Brugmann University Center, guidelines and asked the audience how they dealt with Brussels) examined the treatment of lower pole renal particular aspects from these guidelines. Performing a stones. Current guidelines on lower pole renal stones second-look transurethral bladder resection or the still allow various treatment options. But in De instillation of a sole dose of intravesical chemotherapy Meyer’s view, most lower pole renal stones don’t have after an uncomplicated TURB procedure was discussed. to be treated. If stone-free status is desirable, there Despite the presence of clear guidelines there are still are three options based on their efficacy: PNL, RIRS many variations in implementing these guidelines and ESWL— a sequence that also indicates the least among Belgian institutions. He stressed that the EAU aggressive. In conclusion, if one decides to treat a guidelines are guidelines and not rules nor regulations. lower pole kidney stone, one should use the method with which the doctor has the most proven experience. Endoscopic nephron–sparing management Dr. W. Strijbos (AMC Heerlen, the Netherlands) was Prof. Dr. W. Oosterlinck (University Hospital Ghent) the international guest speaker and shared his

valuable expertise with endoscopic nephron-sparing management of superficial low-grade upper urinary tract urothelial carcinomas. He emphasised the importance of this technique in patients with only one functioning kidney.

By presenting a short video he showed procedural tips and tricks such as where to access the kidney, how to regulate the intra-renal pressure and the depth of resection. This procedure implicates a greater risk than a resection in the bladder because of the proximity of major vessels. He concluded his lecture with a query: What would you do if it were your kidney?

Dr. P. Schatteman (OLV Aalst) gave the concluding presentation with a lecture on HOLEP technique as an alternative to prostate adenomectomy. He described the technique and compared the results to an open adenomectomy or even transurethral resection of a large prostate. HOLEP’s main benefits are the shorter hospital stay, smaller social cost and less perioperative bleeding. The voiding outcome is equally good as the alternatives. The major disadvantages are the extended operation time (mainly due to the morcellation), material costs and urge (incontinence) that may occur mostly in the first post-operative weeks. Despite the fact that it is a first choice for obstructive voiding symptoms (according to the 2015 EAU Guidelines) its use is still not widespread in Belgium.

Social programme Science feeds our brain but we need food as well.

With Salon de Romrée as venue, the participants enjoyed a splendid reception and dinner. Residents had the opportunity to talk and exchange views with the lovely farm gardens as backdrop. Indeed, urology is not only about science and medicine but also about friendship and creating links.

Social media and medicine Harnessing the benefits of social media Dr. Laura Martínez Member, Spanish Residents Workgroup Hospital del Henares Madrid (ES)

lmartinezb@ salud.madrid.org

Dr. Juan Gómez Rivas Internal Coordinator ESRU Chairman, Spanish Residents Workgroup La Paz University Hospital Madrid (ES) juangomezr@ gmail.com Nowadays, and due to the diversity of media, we have access to multiple data sources. Internet offers a wide range of scientific sources, but some may have weaknesses with regards reliability.

In the health sector there are multiple discussion forums with links to general information and the promotion or sales of medicines without a doctor´s prescription, and a wide variety of scientific publications and social networking sites.

Social Media (SoMe) sites such as Facebook or Twitter are changing people lifestyles. We can read current news without subscribing to a newspaper or have automatic TV access auto using smartphones.

SoMe is not only shaping people´s lives, they are also influencing professional environments. Furthermore, a growing majority of patients, specifically those with chronic conditions are checking SoMe and other online sources to acquire health information or get in contact with others affected by similar diseases. In August/September 2015

this way, they play a more active role in their health decisions. All these imply that new technologies will invariably be part of the landscape of present and future medicine.

One drawback is that instant medical information can be obtained by users without being moderated or proper assessment by specialists. SoMe has introduced questions and doubts about confidentiality, informed consent, professionalism and specific ethical issues of special concern to health professionals. Moreover, patients who are now active SoMe users will one day come to our clinics. Chances are they have a wealth of unfiltered health information obtained through the web.

Integrating SoMe benefits While these technologies seem to be expanding their use and influence in healthcare systems, the discussion regarding the dangers of SoMe in medicine has taken a worrying turn. However, some people are urging to focus on SoMe’s potentially positive applications. Today, there are many indications that medical professionals are finding ways to beneficially integrate SoMe into healthcare processes. In addition, SoMe sites serve to connect various medical professionals to their peers and colleagues via online networks such as Facebook, Twitter and more professional-oriented platforms such as LinkedIn and ResearchGate.

A recent study has published a report in which Twitter metrics from eight urology conferences in 2013 were analyzed (BJU International). This study shows substantial social media activity. The two major urology conferences, the EAU and the AUA, each with more than 11,000 participants, generated the most activity. From this perspective, it has been shown that a successful SoMe strategy can provide benefits to the profile of a conference.

The use of Twitter to enhance the urology conference experience has been noteworthy over the past three years. Leading journals, such as BJUI and European Urology, have appointed Associate Editors to implement SoMe strategies. The BJUI has included

regular blogs from the major urology conferences within its SoMe plan. BJUI blogs also provide summary highlights from these conferences, especially convenient to those who are unable to attend.

Thus, many urological associations use SoMe as a means to enhance the conference and bring the experience to a wider audience. Twitter, for instance, is a very powerful tool for expanding the content of scientific meetings and provides timely information.

In ESRU we are improving SoMe usage to communicate with residents in urology regarding news, courses, congress information and events, among other information. This year we have reached more than 700 Facebook likes, and since the creation of our Twitter account this year @ESRUrology have more than 200 followers.

We expect to have an active participation during events were ESRU is involved such as the EAU Regional Office meetings CEM and SEEM, and the EAU Annual Congress to help promote the scientific content of these events and show the highlights to our SoMe followers.

Since SoMe is perceived as a means for people to maintain their links with others, we encourage national residents’ societies to enhance their SoMe participation to achieve stronger links with their members and help improve their communication goals. Italy, Turkey and Spain’s residents’ organizations are good examples of having used effective SoMe strategies.

SoMe may have its drawbacks but used effectively it can lead to better communication with patients and enhance our professional development, eventually contributing to efficient public health research and service.

European Urology Today

25

WCE 2015

5th ESUT Meeting

The World Congress of Endourology and SWL, one of the most prestigious annual events in endourology, will hold its 33rd meeting on October 1 to 4 October 2015 in London (UK).

The EAU Section Uro-Technology (ESUT) will hold its 5th Meeting from July 8 to 10, 2016 in Athens, Greece, with the aim to introduce and familiarise European urologists with technological advancements employed in clinical practice.

The Congress Scientific Committee has organized an exciting program with state-of- the-art lectures by expert guest speakers, and a range of educational activities and opportunities. The faculty, made up of key opinion leaders and innovators as well as upcoming talented young endourologists, will share their experience and expertise, and will discuss the latest research developments.

The key themes up for discussion include the modern management of stones, imaging and focal therapy in oncology, including robotics and new technologies in endourology. The “Better Than Live” surgery and “Expert Educational Video Sessions” will enhance the innovative programme.

The meeting will focus on a comprehensive description and live demonstration of urological procedures using modern instrumentation and a critical evaluation of their benefits and limits. Expert panels will also compare and assess all available treatment options on the same disease for participants to come up with clear conclusions regarding the superiority, or lack of it, of one technique over the other.

www.esut16.org

ESUT16 5th Meeting of the EAU Section of UroTechnology (ESUT) 8-10 July 2016, Athens, Greece EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations

The ESUT meeting will also feature live surgeries to show different techniques for oncologic and reconstructive surgery approaches, and demonstrate the various endoscopic treatment options in the management of stone disease. The programme will also examine focal and radical therapies in kidney and prostate cancers as well as the various emerging approaches in managing benign prostatic obstruction.

Of interest in the 33rd WCE&SWL will be the Paneuropean Endourology Joint Meeting of the EAU Sections of Uro-Technology (ESUT) and Urolithiasis (EULIS), and the Hellenic, Turkish, Russian and Italian Endourology Associations. This joint meeting will Coming soon: www.esut16.org offer an update on European endourology which aims to highlight the role of laparoscopy in the modern era.

Also to be examined are new trends in ESWL, comparative data between flexible ureteroscopy and mini PCNL, the emerging role of en-block transurethral resection of bladder tumours and the outcomes of novel approaches in the management of benign prostatic obstruction. More information at:

ESUT Live surgery in progress

Will you be an EAU Award Winner in Munich?

EAU Crystal Matula Award 2016 For a young promising urologist under the age of 40 who has the potential to become one of the future leaders in academic European urology. National Societies can nominate a candidate for this award or eligible candidates can apply by contacting their national urological society directly.

EAU Hans Marberger Award 2016 For the Best Paper published on Minimally Invasive Surgery in Urology. This paper must have been published or accepted for publication between 1 July 2014 and 30 June 2015.

Apply for your EAU membership online!

EAU Prostate Cancer Research Award 2016 For the Best Paper on Clinical or Experimental Prostate Cancer Research. The paper must have been published or accepted for publication in a high-ranking international journal between 1 July 2014 and 30 June 2015.

EAU Best Paper Awards 2016 For the two Best Papers published in Urological Literature on Clinical and Fundamental Research. These papers must have been published or accepted for publication between 1 July 2014 and 30 June 2015.

Apply now and win!

Would you like to receive all the benefits of EAU membership, but have no time for tedious paperwork?

Becoming a member is now fast and easy!

Deadline: 1 November 2015 For more information, rules and regulations: www.eau16.org/the-congress/awards

www.eau16.org

26

European Urology Today

#EAU16

European Association of Urology

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!

European Association of Urology

August/September 2015

7th European Multidisciplinary Meeting on Urological Cancers

Coming soon…

EMUC 2015 app

In conjunction with • ESU courses on Medical treatment of metastatic renal cancer and Castrate resistant prostate cancer • European School of Oncology: Personalised approach to prostate cancer management • 4th Meeting of the EAU Section of Urological Imaging (ESUI) • Young Academic Urologists meeting

Optimising opportunities in multidisciplinary care 12-15 November 2015, Barcelona, Spain

Scientific Programme EMUC2015 is held in conjunction with:

12.10-12.25

Thursday, 12 November 08.30-18.00

4th Meeting of the EAU Section of Urological Imaging (ESUI)

08.30-17.30

European School of Oncology Conference - Personalised approach to prostate cancer management

14.00-17.00

European School of Urology Courses on Medical treatment of metastatic renal cancer and Castrate resistant prostate cancer

Friday, 13 November

ESU-ERUS Hands-on Training Courses

12.25-12.40

12.40-13.55 12.55-13.55

Lunch and poster viewing Industry session

13.55-14.10

Best of Journals: Medical oncology Chairs: Medical oncologist - A. Necchi, Milan (IT) Medical oncologist - J. Oldenburg, Oslo (NO)

14.10-15.25

Saturday, 14 November Workshop Falcon ESU-ERUS Hands-on Training Courses Sunday, 15 November Young Academic Urologists Meeting

14.10-14.25 14.25-15.25

Friday, 13 November 08.15-08.25

08.25-10.50

08.25-08.45 08.45-09.05 09.05-09.25 09.25-09.45 09.45-10.20

10.20-10.40

10.40-10.50

Welcome and Introduction Medical oncologist C.N. Sternberg (ESMO) Radiation oncologist P. Poortmans (ESTRO) Urologist H. Van Poppel (EAU) Radiologist H. Thoeny (ESUR) Pathologist A. Lopez-Beltran (ESP/ ESUP) What’s new in prostate cancer?

From epidemiology to genomics Chairs: Medical oncologist - T. Powles, London (GB) Radiation oncologist - M. Bolla, Grenoble (FR) Urologist - R. Karnes, Rochester (US) The changing landscape of prostate cancer epidemiology Epidemiologist - Ahmedin Jemal, Atlanta (US) Is Gleason score outdated? The new prognostic grading system Pathologist - R. Montironi, Torette di Ancona (IT) Use of MRI-guided biopsy: A real step forward?

TBC Genomics: When and for whom Urologist - J. Catto, Sheffield (GB) Clinical case discussion on “locally advanced” prostate cancer Case presenter: Urologist - F. Chun, Hamburg (DE) Medical oncologist - C. Massard, Villejuif (FR) Radiation oncologist - P. Ost, Ghent (BE) Radiologist - H. Thoeny, Berne (CH) Urologist - K. Touijer, New York (US) State of the art lecture: Next generation pathology: Predicting clinical course and targeting disease causation Chair: Medical oncologist - C.N. Sternberg, Rome (IT) Speaker: Pathologist - C. Cordon-Cardo, New York (US) RA 223: From clinical to real live practice Oncologist - J. Carles, Barcelona (ES)

10.50-11.10

Coffee break and poster viewing

11.10-12.40

Prostate cancer in the young patient Chairs: Medical oncologist - S. Osanto, Leiden (NL) Radiation oncologist - R. Valdagni, Milan (IT) Urologist - M. Wirth, Dresden (DE)

11.10-11.25 11.25-11.40 11.40-11.55 11.55-12.10

Biomarkers at young age: PSA and beyond Biostatistician - A. Vickers, New York (US) The role of screening in younger patients Urologist - M. Roobol, Rotterdam (NL) Is active surveillance too risky in young men?

Urologist - C. Bangma, Rotterdam (NL) The perfect curative treatment at long term: What can we achieve?

August/September 2015

Urologist - R. Karnes, Rochester (US) Long-term survivorship and quality of life after curative treatment Medical psychologist - F. Mols, Tilburg (NL) Update on clinical trials in prostate cancer Chair: Urologist - F. Chun, Hamburg (DE) Speaker: Urologist - P. Ghadjar, Berlin (DE)

Metastatic kidney cancer Chairs: Radiation oncologist - G. De Meerleer, Ghent (BE) Urologist - M. Kuczyk, Hanover (DE) Medical oncologist - S. Osanto, Leiden (NL)

Coffee break and poster viewing

16.00-16.40

Update on systemic treatments in bladder cancer Chairs: Clinical oncologist - R. Huddart, Sutton (GB) Urologist - H. Van Poppel, Leuven (BE)

16.10-16.20 16.20-16.30 16.30-16.40 16.40-17.20

16.40-16.50

Peri-operative chemotherapy Medical oncologist - C.N. Sternberg, Rome (IT) Targeted therapies Medical oncologist - M. De Santis, Coventry (GB) Immune therapy Medical oncologist - T. Powles, London (GB) Discussion Testis cancer session Chairs: Urologist - N. Mottet, Saint-Étienne (FR) Medical oncologist - A. Necchi, Milan (IT)

17.10-17.20

Optimal imaging for disease recurrence Radiologist - M. Bertolotto, Trieste (IT) Management of residual masses after RPLN Urologist - V. Matveev, Moscow (RU) Report from ICUD Medical oncologist - J. Oldenburg, Oslo (NO) Discussion

17.30-18.30

Industry session

16.50-17.00 17.00-17.10

10.20-10.35 10.35-10.50 10.50-11.05 11.05-11.20

Urologist - L. Martínez-Piñeiro, Madrid (ES) Pathology features with prognostic implications Pathologist - E. Compérat, Paris (FR) Biomarkers in non-muscle invasive bladder cancer Urologist - M. Ribal, Barcelona (ES) What can we ask to imaging in non-muscle invasive bladder cancer?

Radiologist - V. Panebianco, Rome (IT) Surgical management: Oncological outcomes and follow-up Urologist - C. Stief, Munich (DE) Update on clinical trials in urothelial carcinoma Urologist - S. Shariat, Vienna (AT)

11.20-11.50

Coffee break and poster viewing

11.50-12.50

MDT case of patient with muscle invasive bladder cancer with minimal nodal invasion Chairs: Medical oncologist - J. Bellmunt, Boston (US) Radiation oncologist - B. Jereczek-Fossa, Milan (IT) Urologist - G. Thalmann, Berne (CH)

Intratumoral heterogeneity in kidney cancer Medical oncologist - S. Turajlic, London (GB) Clinical case discussion on metastatic RCC Case presenter: Urologist - A. Volpe, Novara (IT) Radiologist - G. Heinz-Peer, Saint Poelten (AT) Pathologist - F. Algaba, Barcelona (ES) Medical oncologist - L. Albiges, Villejuif (FR) Urologist - V. Matveev, Moscow (RU) Radiotherapist - C. Cozzarini, Milan (IT)

15.25-16.00

16.00-16.10

10.05-10.20

Case presenter YAU: Urologist - E. Xylinas, Paris (FR) Radiation oncologist - A. Kiltie, Oxford (GB) Pathologist - A. Lopez-Beltran, Lisbon (PT) Radiation oncologist - L. Moonen, Amsterdam (NL) Medical oncologist: M. Galsky, New York (US) Urologist - A. Stenzl, Tübingen (DE) 12.50-13.05

Best of journals: Surgery Chairs: Urologist - F. Montorsi, Milan (IT) Biostatistician - A. Vickers, New York (US)

13.05-14.20 13.20-14.20

Lunch and poster viewing Industry session

14.20-15.10

Kidney cancer: Novel approaches in advanced renal cancer Chairs: Urologist - A. Minervini, Florence (IT) Urologist - P. Mulders, Nijmegen (NL) Medical oncologist - T. Powles, London (GB)

14.20-14.30 14.30-14.40 14.40-14.50 14.50-15.00 15.00-15.10

Vaccine therapies Medical oncologist - L. Albiges, Villejuif (FR) Understanding the immunology of advanced RCC: The role of checkpoint inhibitors Medical oncologist - D. McDermott, Boston (US) Tumour response assessment Urologist - J. Bedke, Tübingen (DE) Update on neo-adjuvant and adjuvant therapies Urologist - A. Bex, Amsterdam (NL) Discussion

15.10-16.00

Rare kidney tumour session Chairs: Urologist - U. Capitanio, Milan (IT) Pathologist - E. Compérat, Paris (FR) Urologist - M. Hohenfellner, Heidelberg (DE)

Oral presentations of the 6 best abstracts Chairs: Radiotherapist - C. Cozzarini, Milan (IT) Medical oncologist - M. De Santis, Coventry (GB) Urologist - F. Sanguedolce, London (GB)

15.10-15.20

09.10-09.20

Announcement 3 best unmoderated posters Chairs: Medical oncologist - J. Bellmunt, Boston (US) Urologist - J. Walz, Marseille (FR)

15.40-15.50 15.50-16.00

Can a radiologist influence treatment approach?

Radiologist - Giuseppe Petralia, Milan (IT) Rare tumours Medical oncologist - G. Malouf, Paris (FR) Hereditary cancers Pathologist - G. Martignoni, Verona (IT) Discussion Ongoing clinical trials in kidney cancer Medical oncologist - S. Osanto, Leiden (NL)

09.20-11.20

Bladder cancer: Management of carcinoma in situ Chairs: Medical oncologist - M. Galsky, New York (US) Urologist - P. Gontero, Turin (IT) Urologist - M. Rouprêt, Paris (FR)

09.20-09.35

Update on the genome cancer atlas Urologist - S. Lerner, Houston (US) Optimal management of carcinoma in situ The role of Hexvix Urologist - F. Witjes, Nijmegen (NL) The optimal conservative management for CIS

Saturday, 14 November 08.30-09.10

09.35-09.50 09.50-10.05

15.20-15.30 15.30-15.40

16.00-16.20

Coffee break and poster viewing

16.20-16.50

Late breaking news Chairs: Urologist - TBC Radiation oncologist - P. Poortmans, Nijmegen (NL)

16.50-17.10

Best of journals: Radiotherapy Chairs: Radiation oncologist - P. Poortmans, Nijmegen (NL) Radiation oncologist - G. De Meerleer, Ghent (BE)

17.10-17.25

State of the art lecture on genomics/ personalised medicine Chair: Urologist - A. Briganti, Milan (IT) Speaker: Urologist - T. Schlomm, Hamburg (DE)

17.25-18.05

Management of upper urinary tract transitional cell carcinoma Chairs: Urologist - S. Shariat, Vienna (AT) Urologist - J. Walz, Marseille (FR)

17.25-17.35

17.55- 18.05

When is organ sparing allowed?

Urologist - M. Rouprêt, Paris (FR) Role and extent of lymph node dissection during nephroureterectomy Urologist - M. Brausi, Modena (IT) When and how to use chemotherapy Clinical oncologist - R. Huddart, Sutton (GB) Discussion

18.15-19.15

Industry session

17.35- 17.45 17.45-17.55

Sunday, 15 November 09.15-09.25

Announcement 3 best unmoderated posters Chairs: Radiologist - H. Thoeny, Berne (CH) Urologist - B. Tombal, Brussels (BE)

09.25-11.15

Prostate cancer: Oligo-metastatic disease Chairs: Medical oncologist - K. Fizazi, Villejuif (FR) Clinical oncologist - V. Khoo, London (GB) Urologist - F. Montorsi, Milan (IT)

09.25-09.40

When science meets the clinics: The rationale beyond cytoreductive approaches in prostate cancer Urologist - A. Bjartell, Malmö (SE) Management of oligo-metastatic prostate cancer Clinical case presented by Urologist - C. Surcel, Bucharest (RO) Clonal heterogeneity and prostate cancer metastases Pathologist - M. Haffner, Baltimore (US) What can surgery offer?

Urologist - S. Joniau, Leuven (BE) Optimal radiotherapy for imaging detected recurrence Radiation oncologist - A. Bossi, Villejuif (FR) Optimizing hormonal manipulation Urologist - B. Tombal, Brussels (BE) Docetaxel: From the start?

Medical oncologist - K. Fizazi, Villejuif (FR)

09.40-10.00 10.00-10.15 10.15-10.30 10.30-10.45 10.45-11.00 11.00-11.15 11.15-12.05 11.15-11.25 11.25-11.35 11.35-11.45 11.45-11.55 11.55-12.05

Take home messages Radiologist Urologist Medical oncologist Radiation oncologist Pathologist

12.05-12.15

Closing remarks Medical oncologist Radiation oncologist Urologist

H. Thoeny, Berne (CH) A. Briganti, Milan (IT) S. Osanto, Leiden (NL) A. Bossi, Villejuif (FR) A. Lopez-Beltran, Lisbon (PT) C.N. Sternberg (ESMO) P. Poortmans (ESTRO) H. Van Poppel (EAU)

New levels of interactivity with the IML Connector • Message the session chairman • Cast your vote

European Urology Today 27 www.emuc15.org

ESUI15

#ESUI15

Imaging and Individualised Medicine

4th Meeting of the EAU Section of Urological Imaging In conjunction with the 7th European Multidisciplinary Meeting on Urological Cancers

12 November 2015, Barcelona, Spain

Jurgen Futterer (NL), ESUI Ex-Officio

Imaging in prostate cancer: MRI’s role to expand in the next decade The role of imaging techniques such as multiparametric Magnetic Resonance Imaging (MP-MRI) will expand in the next few years and will have a more central role in the diagnosis of prostate cancer (PCa), particularly in cases where new technologies are combined to yield more detailed images.

MRI? Mandatory sequences and PIRADS 2.0.” The lecture is part of a PointCounterpoint session where experts will debate on whether MRI detects significant prostate cancers. ESUI Chairman Jochen Walz (FR) will present counter arguments while Dr. H.U. Ahmed (GB) would argue in favor of MRI.

“MP-MRI will play an important role in guiding both biopsy as well as focal therapy,” said radiologist Dr. Jurgen Futterer of the Radboud UMC in Nijmegen (NL). Futterer will lecture during the upcoming 4th Meeting of the EAU Section of Urological Imaging (ESUI) on November 12 in Barcelona, Spain. The 4th ESUI will be held in conjunction with the 7th European Multidisciplinary Meeting on Urological Cancers (EMUC).

Futterer will discuss the essential imaging sequences (T2-weighted anatomical imaging, diffusion weighted imaging and contrast enhanced MR imaging) in his lecture, highlighting the role of each procedure. He will also look into the role and application of PI-RADS v2, the second and revised version of Prostate Imaging-Reporting and Data System (PI-RADS) which refers to a structured reporting scheme for prostate cancer.

“MP-MRI can detect clinical significant cancers in males with rising PSA and negative biopsies. The negative predictive value is around 95% (this is based on a recent systematic review in European Urology). However, non-significant cancers may be missed (Gleason 6 cancers). MP-MRI can be applied in patients who are opting for active surveillance and active treatment follow-up,” explained Futterer when asked how doctors can achieve optimal treatment results.

With the emphasis on sophisticated imaging techniques in recent years, Futterer said he expects to see new developments which will eventually impact PCa diagnosis.

“Moreover, MP-MRI can be used to select patients for focal therapy,” he added while underscoring that optimal PCa treatment will increasingly rely on imaging results and capabilities.

Futterer will lecture on the topic “What is the new standard of prostate

Jochen Walz (FR), ESUI Chairman

In current guidelines, according to Futterer, MP-MRI is recommended in certain indications. “I think that imaging has a more prominent role,” he noted given the fact the doctors need a tool that will allow them to draw more informed conclusions, enabling optimal treatment strategies.

Regarding challenges in the field of imaging for urological cancers, he noted the role of prostate-specific membrane antigen (PSMA) PET imaging in detecting lymph node metastasis. “Currently, imaging is limited for lymph node metastases,” he said implying that experts need to further look into the role of PSMA. The ESUI Meeting has prepared an exciting programme which will cover the most recent developments in urological imaging, with topics up for discussion and debate in a number of roundtable sessions. The day-long agenda will take up individualised medicine, new imaging technologies on the horizon, molecular imaging (in a joint session with the European Association of Nuclear Medicine) and optimising PC a management, among other topics.

“Most likely diffusion weighted imaging will evolve into a biomarker for cancer aggressiveness. Furthermore, finger printing imaging techniques will be available in which from one MR imaging sequence acquisition we will able to extract different tissue contrast,” he said.

Before this happens, however, more research into the exact role of imaging needs to be done, particularly in the multi-disciplinary setting where various prostate cancer experts are involved in the treatment management.

For programme information and registration details, visit the event website at www.esui15.org

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August/September 2015

CEM15

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EAU 15th Central European Meeting 2-4 October 2015, Budapest, Hungary CEM 15: Focus on core urological specialties Achieving expertise in core urological specialties and acquiring the most recent updates on treatment strategies will be the focus of the 15th Central European Meeting (CEM) which will take place in Budapest, Hungary from 2 to 4 October.

“The meeting will cover the most recent advances in uro-oncology, with special focus on the new diagnostic and treatment possibilities in prostate cancer. There is a session on functional urology and we will have an ESU course on urological Infections since urinary tract infections and antibiotic resistance have now became one of the biggest threats urologists have to face today,” said Prof.

Péter Tenke, chairman and course director of the 15th CEM. CEM is the longest-running and frontline meeting annually organised by the EAU’s Regional Office, headed by Prof. Bob Djavan. In organising the meeting, Tenke underscored the importance of CEM in providing an effective platform for urologists in the region: “The Central European Meeting is a great occasion for the urologists in the region to meet and strengthen their social and scientific network and also to share knowledge. It is also the ideal meeting for young urologists to improve their skills in public speaking or in presenting data, preparing them for the EAU’s Annual Congress,” he added.

Budapest has a special place in the CEM’s history as it was the city that first hosted the annual meeting way back in 2001. CEM returned in 2005, making Budapest the only city to host the meeting for the third time.

Tenke is proud of the achievements by urologists in the region. “The Central European region always had an important role in European urology, as many of the finest urologist surgeons are from here. Our goal is to maintain this position and to educate the next generation since they represent our region.

They are the future.”

There are, however, daunting challenges in the horizon, particularly at a time of financial crisis or constraints. Tenke underscored that fast-changing technical developments also have an impact on how doctors educate or train themselves, and the extent of support they can get from their hospitals.

“We live in an era of continually increasing technical solutions in surgery. Although these solutions provide better opportunities and results, they also represent a significant financial burden to the

hospitals,” he said. “It is also a challenge to be continually updated with the newest guidelines and techniques. To achieve this, urologists must continually educate themselves and participate in international congresses such as the CEM.” The CEM’s Scientific Programme will cover in two-and-a-half days a range of topics with special emphasis on uro-oncology. New medical and surgical treatment options in prostate, bladder and kidney cancers will be presented in the first day in various panel discussions, lectures and debates, among others. On the second day, the ESU course on urological infections will tackle complications from prostate biopsies and severe urological infections. A session on functional urology will focus on prolapse surgery and new drugs for overactive bladder, among other topics.

The Young Urologists Competition will also feature promising talents presenting their arguments, findings and views on controversial topics in uro-oncology. A recently introduced feature, the competition is one of the meeting’s highlights and complements the Best Poster Awards, annually given to the most innovative and significant research studies done by young urologists.

Accepted abstracts will also be published online

by Elsevier as an official supplement of European Urology, while winning abstracts will be highlighted in the EAU’s Annual Congress in Munich next year.

For registration information and programme overview, visit the meeting website at: www.cem15.org

ESOU16 13th Meeting of the EAU Section of Oncological Urology (ESOU)

#ESOU16

15-17 January 2016, Warsaw, Poland

Early fee registration deadline: 1 November 2015 Online registration deadline: 11 January 2016

Registration has opened!

The 2016 ESOU meeting is set to offer delegates a highly specialised, three-day scientific programme, which covers all aspects of oncological urology. The latest insights and techniques will be presented by speakers from across the world, also offering a high degree of interaction that a specialised meeting like this can achieve.

Expert speakers will give key updates and discuss the current state of oncological urology, including prostate, bladder, renal and testis cancer. The programme will feature video and poster sessions, debates, case presentations and opportunities for informal interaction. ESOU16 takes place in Warsaw, a wonderful and charming Central European city full of history and tradition.

ESU-ERUS Hands-on training The European School of Urology and the EAU Robotic Urology Section are working together to offer ESOU16 delegates a chance to work on their robotic surgery skills. On Friday and Saturday, there are four 90-minute slots available for one-on-one training with expert tutors. The hands-on training sessions are designed to improve the participants’ control-skills and hand-eye-coordination, as well as acting as an objective benchmarking of console performance and an introduction into standardized surgical steps in robot-assisted procedures.

A session costs €26, excl. VAT. You can sign up for a hands-on training session when you register for ESOU16. If you already registered, you can send an e-mail to registrations@congressconsultants.com, clearly mentioning ESOU16.

August/September 2015

STEPS Programme ESOU16 marks the sixth time that a Sessions To Evaluate ProgresS in the management of urological cancers (STEPS) is organised.

Twenty young clinicians who are already practising, or who have a firm career interest in onco-urology will be selected through an open application process to meet established experts in the fields of prostate, bladder, renal and testicular cancer.

With unrestricted educational support from Ipsen, STEPS allows young clinicians take part in a three-hour closed-door case discussion which aims to: • Offer an innovative educational opportunity to selected young clinicians • Strengthen ties between ESOU and talented younger clinicians in onco-urology • Boost the participant’s professional network with both established and emerging experts in uro-oncology.

Successful applicants will be sponsored to attend ESOU16 (to cover travel, accommodation and registration).

Applications must be received by Friday, October 2nd. Successful applicants will be notified by Friday, November 6th. Further information on the STEPS programme, the requirements and how to apply can be found on www.esou16.org For registration or programme information: www.esou16.org

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SEEM15 EAU 11th South Eastern European Meeting

Early registration deadline: 20 September 2015

6-8 November 2015, Antalya, Turkey Southern Turkey to host 11th South Eastern European Meeting When the South Eastern European Meeting comes the south coast of Turkey in November, delegates can expect a world-class congress experience. SEEM is designed as a regional extension of the Annual EAU Meeting, with the same diversity of topics, speakers, and courses.

In addition to the Young Urologists Competition, the poster sessions act as a stage for young urologists from South Eastern Europe and neighbouring countries. “SEEM acts as an international, Englishlanguage platform for presenting regional research,” Djavan said.

“The Annual EAU Congress might be daunting for novice presenters for whom English is a second or even third language. SEEM allows them to get used to presenting in English, while showcasing their research. We will be choosing six best speakers and in addition to a sponsored prize, we will be inviting them to present at EAU16 in Munich next year.”

EAU Regional Office Chairman, Prof. Bob Djavan spoke to European Urology Today about the ongoing preparations for SEEM15, its appeal, as well as the Office’s approach to regional meetings in general. SEEM15 will take place in sunny Antalya on 6-8 November, 2015.

Scientific Programme Delegates can look forward to a large variety of topics and sessions over the course of the three days, including but not limited to stateof-the-art lectures from international experts, hands-on training, and poster and video presentations.

“SEEM is an attractive alternative for urologists who are interested in what the EAU has to offer, but who cannot attend the Annual Congress for various reasons, including cost. By hosting regional meetings across Europe every year, we can offer urologists from the region and beyond the same scientific standard and international speakers as they might get at the Annual Congress. We routinely welcome urologists from the former Soviet Union, from Western and Central Asia and from North Africa.”

Prof. Djavan: “The scientific programme of the SEEM and other regional offices is composed by the countries of the respective region, involving their national society’s president, and a key opinion leader. In that sense the scientific programme is shaped by the region, and reflects their needs and priorities. The EAU assesses the quality of the programme and more or less ‘confirms’ it.”

A popular and unique feature of SEEM and other regional meetings is the “Young Urologist Competition”, in which participating countries nominate one delegate to speak on a certain topic. Prof.

Djavan: “This adds a fun, competitive element to the meeting. In a sense it levels the playing field, allowing smaller countries to ‘triumph’ over their larger neighbours. All in the spirit of friendly competition, of course.”

Regional Office With the reinstatement of the Baltic Meeting, the EAU Regional Office now organises three major scientific meetings every year.

Prof Djavan is grateful to the EAU Executive’s increased support for the Office’s initiatives, which now also includes the establishment of cooperative research groups.

Djavan: “The EAU offers logistical support to these regional research groups, encouraging cross-border cooperation. That way they can jointly write and submit articles to journals and abstracts to meetings.” The envisioned regional cooperation also includes the exchange of residents and young urologists. “Not everyone should have to travel to London or Paris for training or work experience, in some cases they can find this closer to home.”

Early registration fees for SEEM15 apply until September 20th. For all the latest information on the scientific programme, registration, training courses and the venue, please visit www.seem15.org

Venue and Accommodation For the first time, SEEM will take place in Antalya, Turkey, a region known for its hospitality, charm and vibrant cultural life. The Gloria Golf Resort is a high-quality, all-inclusive resort. For convenience, we strongly advise that you book your room at this resort. The EAU has arranged a number of rooms at a special rate for delegates. These are available on a first-come, first-served basis, so please book as soon as possible! You can find more information about booking your room on www.seem15.org

6th International Congress on the

History of Urology In conjunction with EAU16 11 March 2016, Munich, Germany

Full-day scientific programme takes shape The organising committee of the 6th International Congress on the History of Urology has successfully attracted a wide range of speakers on a variety of topics. Topics and speakers were suggested from across the globe, and extra attention was paid to include speakers from every continent, making this a truly “international” congress.

The History Congress is organised in conjunction with the 31st Annual EAU Congress in Munich, taking place on its first day, March 11th.

Preliminary Scientific Programme The scientific programme is arranged in four thematic blocks, covering the worldwide roots of urology, politics and urology, sex around the world and pioneers in urology.

The last part promises to include actual urological legends, speaking on their career, challenges and breakthroughs, while of course taking questions from the audience.

Other preliminary topics include the origins of urology in Egypt and Japan, and the story of a urologist from Argentina who settles in the Soviet Union for ideological reasons. The second part of the scientific programme deals with the fall of the iron curtain and its effects on urology, and the urological complications that changed world history. Sex and andrology dominate the third part of the day, including Germany’s sexual revolution and the birth of modern andrology.

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Attendance We are also pleased to announce that attendance to the History Congress is included without extra charge in the registration for EAU16. If you are attending EAU16, you are free to come to the sessions of the History Congress as you please. For those who are interested in attending the History Congress without attending the rest of EAU16, special rates are available.

For more information on the preliminary scientific programme and how to register, please visit: www.eau16.org/history-congress

Prof. F. Debruyne Honorary Congress President

www.eau16.org/history-congress August/September 2015

EAUN Conference Scholarship Awards Opportunity for European nurses to join the EAUN Meeting for free

l.drudge-coates@ eaun.org In time for Munich 2016, we are truly delighted and proud to announce the launch of the inaugural EAUN Meeting Scholarships Awards in association with Astellas Pharma, partners who recognise the critical role of urology nurses in patient care and understand the importance of developing urological nursing.

As new technology and treatments continue to evolve, education remains essential as urology nurses will play an even more critical role in patient care. Making sure we provide development opportunities for urological nurses to improve their knowledge of and skills in urology through education and training is, therefore, essential.

“These awards have been specifically designed to provide financial assistance to urology nurses across Europe to attend the annual EAUN Meeting to help develop both clinical practice and optimise patient care.”

Europe to attend the annual EAUN Meeting to help develop both clinical practice and optimise patient care. The annual scholarship awards will support up to 10 nurses based in Europe for them to participate in the EAUN Meeting by providing €500 towards the costs of travel, registration and accommodation. Candidates will be required to be working in urology and be current EAUN members.

Not a member? Don’t lose out of this great opportunity!

For those of you who are currently non-members, you are also eligible to apply for the grant provided you have submitted a paid membership application to the EAUN. For membership details please go to. http://nurses.uroweb.org/nurses/membership Each applicant will be required to submit a 300-500 word statement in English for a blinded panel review, which must clearly specify how you

and patient care will benefit from this opportunity All submissions should be filed by 1 November 2015. Successful applicants will be notified of the award by the 4th of December 2015, within the time frame for the early bird registration (1st October – 12th January 2016).

Following the Meeting, each successful candidate will be required to write a review of the experience of attending the conference in English and how their learning will be used in clinical practice. The article will be published in the European Urology Today and email newsletter. Further details on the application process and criteria will be published in the EAUN website.

And remember if you’re not an EAUN member, now is the perfect time to join and take advantage of this great opportunity!

EAUN Board Chair

Chair Elect Past Chair Board member Board member Board member Board member Board member Board member

Lawrence DrudgeCoates (UK) Stefano Terzoni (IT) Kate Fitzpatrick (IE) Paula Allchorne (UK) Simon Borg (MT) Erica Grainger (DK) Corinne Tillier (NL) Susanne Vahr (DK) Giulia Villa (IT)

www.eaun.uroweb.org

www.eaun.uroweb.org

Lawrence DrudgeCoates Urological Oncology Clinical Nurse Specialist Chair EAUN London (UK)

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!

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!

These awards have been specifically designed to provide financial assistance to urology nurses across

European Association of Urology European Nurses Association of Urology Nurses

European Association of Urology Nurses

Share your experience and ambition in Munich

Fellowship Programme

12-14 March 2016, Munich, Germany

European Association of Urology Nurses

Nursing research may bring the most amazing results With the EAUN’s commitment to support innovative work, we invite you to submit a research project proposal for the EAUN Nursing Research Competition. The topics that have to be included in the project plan and examples can be found on our website.

During the 17th International EAUN Meeting in Munich (12-14 March 2016), all projects of the nominees will be discussed in a scientific session, enabling all participants to learn through feedback and discussions. A winner, chosen from the final nominees selected by a jury, will receive € 2,500 to (partly) fund the research project.

Supported with an educational grant by

Join our search for Nursing Solutions in Difficult Cases If you are among those who encounter atypical cases in daily practice and have found your own solutions, we would like to invite you to take a few photos and write a standard protocol. You can download a form with a list of standard questions.

The form should include a description of the problem, the nursing intervention provided, the material you have chosen to help the patient and the final results.

Please note: Difficult cases that have not been (completely) solved may also be submitted. The best cases will be rewarded with a free registration for the congress.

Detailed submission criteria and rules for both submissions can be found at the congress website.

Submission deadline: 1 December 2015 For more information please contact the EAUN at eaun@uroweb.org.

www.eaun16.org August/September 2015

European Association of Urology Nurses

Visit a hospital abroad!

1 or 2 weeks - expenses paid Application deadline: 31 January 2016 • 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 eaun@uroweb.org www.eaun.uroweb.org

European Association of Urology Nurses

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“By Nurses, for Nurses” New video session format at 17th EAUN Meeting in Munich Simon Borg, Rn EAUN Board Member Mater Dei Hospital Inpatients Theatre Msida (MT)

s.borg@eaun.org The ‘Inside the Body - Surgery in Motion’ session that we had for three years at the annual EAUN meetings will be presented in a new format starting with the 17th International EAUN Meeting in Munich next year. Why do we organise a video session at every International EAUN Meeting?

Why we need it The initial objective was to show on-screen the excellent work by urological specialists and present it to our colleagues in nursing. As urology nurses many of us actually only get to see the result and outcome of such specialised work. Thus, the “Inside the Body” session, serves as a window that allows a closer look into these surgical procedures. It was a simple concept that worked, but like all good things in life it may have run its course in its current format. Time for a change.

It is said that “action changes things” and with that inspiration in our mind for the EAUN meeting in Madrid, we worked hard to look for innovations in our video selection. Unfortunately, we ended up with half the confirmed speakers not showing up at all. Adding insult to injury, the session, booked in a very expensive hall, was poorly attended by our urology nursing colleagues. Was it the time of day?

Was it due to a very popular session held at the same time just across the corridor?

European Association of Urology Nurses

Perhaps, the aforementioned reasons were part of the low attendance but I would prefer to look at things with a larger lens and a critical eye. My conclusions and proposed measures are as follows: Sometimes, we are looking but not seeing. The reason behind such a poor showup is much clearer and closer at home. Simply put, urology nurses want to see on screen what other urology nurses are up to, full stop. There are out there a plethora of avenues and media platforms with opportunities to see innovative work by urology specialists. On the other hand, for nursing procedures there are very little, indeed, by comparison. Are we, as urology nurses so conservative and not innovative enough? I don’t think so. But have we been confined to the status quo with some excellent but sporadic bursts of well-researched and published accompaniments from the selective few?

Research Project Plan presentation by Helle Syhler (DK) at the 16th EAUN Meeting in Madrid, March 2015

I put forward a challenge to all urology nurses. Why not splice together a 10-minute video presentation of what you are doing and which you believe should be shared with us? What could be shown, you may ask.

Certainly, a well-presented narrative or experience that made a positive difference in one’s practice. It may not even be a video after all but a collage of photos documenting a process that has one fundamental feature – innovative nursing practice.

Let me share thoughts and examples: Example One: I know that there are urology nurses who have served in far-away countries and that’s not something we often see. Why not have presentations on these experiences? I wonder how such an experience can be applied out there, literally in the field. Last year, during our meeting in Madrid, I had the pleasure of meeting such a person. I was impressed by the enthusiasm of this very competent urology nurse when she shared her experience.

Wouldn’t it be wonderful to see it on-screen and spread the joy?

Example Two: Mention the word “Da Vinci” and it’s an instant turn-off for most of us in the nursing community. Indeed it is a wonderful tool but no disrespect intended, many still look at it as the toy that someone else gets to play with in another greener, playpen. Yet, very few know that there are highly competent nurses who have earned specific tasks as key Da Vinci team members. Wouldn’t it be a refreshing change during a nursing meeting to see the preparations specifically performed by a nurse first assistant specialised in robotic surgery? With all the Da Vinci work being carried out there, there must be a video or two to be made.

Example Three: This example is almost the direct opposite to the first. Is there anyone out there who has experienced and documented urology nursing being upheld during difficult circumstances such as a national emergency or even in conflict conditions?

It may not be as uplifting as the voluntary work earlier mentioned, but such presentations give out a

strong message of hope and testament to the stamina of many of our colleagues.

Socrates left us some words of wisdom: “The secret of change is to focus all of your energy, not on fighting the old, but on building the new.”

The transition from the “Inside the Body” sessions to “By Nurses, for Nurses” is not something the EAUN Scientific Committee can build on their own. It is your contribution that will be “building the new” and setting a path that others will choose to follow and emulate.

Some reminders: Deadline for submissions is on 1 December 2015.

For details on the EAUN Meeting and submission requirements, check the Scientific Programme page at the congress website www.eaun16.org.

Abstract, Research Project, Difficult Case and Video presentation deadline: 1 December 2015 Early registration deadline: 15 January 2016

12-14 March 2016, Munich, Germany

EAUN’s Munich programme: Focus on core nursing issues Priority topics include challenges in oncology and training issues The EAUN’s Scientific Programme in Munich next year will attempt to address not only the most pressing issues in education and training but also topics that would enable urology nurses to respond to major healthcare concerns such as Europe’s ageing population, quality of life, cancer, and ethical questions, among many others.

“We intend to introduce several new topics suggested by delegates who attended the Madrid congress this year. Urological issues among young adults, sexuality and cancer, rare or difficult diseases in urology, painful bladder syndrome, and ethics in urological nursing are just a few examples,” said Stefano Terzoni (IT) chairman of the EAUN Scientific Programme Committee.

Terzoni said the EAUN based the programme’s content on topics listed or mentioned by its members. “Feedback from members is always sought and taken into consideration and I believe we are on the right track.

Although there are differences in nursing practices and local rules across a region that is vast and varied as Europe, Terzoni noted there are also commonalities in nursing care and strategies. He mentioned health issues such as overactive bladder (OAB) and urinary tract infections (UTIs) which affect many populations in Europe.

“Many nursing issues are often overlooked and these have an impact on the patient’s autonomy and quality-of-life. Self-care is becoming more and more important in Europe with its high elderly population,“ he said. “Another nursing concern is our ability to ex-

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tend optimal care to patients with multiple co-morbidities and disabilities. These issues will become more prominent in the future.”

Mobility in Europe Mobility of European nurses across the region is also a top priority, according to Terzoni. He said there is increasing concern over the ability of nurses to successfully work and re-settle in other European countries since their mobility is impeded by factors such as the lack of formal recognition or accreditation of credentials.

A nurse who invested time and formal training in a specialised field such as urology, only to end up working in a completely different area in another country is not only a waste of human resources, but also frustrates professional growth,” Terzoni said.

In respond to this challenge, he mentioned the initiatives of the EAUN to engage its European partners. “An attempt is being made across several European countries to create a common framework for education. We are working actively on this,” noted Terzoni.

“With more young nurses moving across Europe, a common structure for defining a urology nurse and how their competence should be acknowledged is really an urgent matter,” he added.

Active support The EAUN’s active support for European nurses is shown by its offer of free or reduced registration fees to nurses interested to participate in the annual EAUN meeting, according to Terzoni. With fewer

Lawrence Drudge-Coates, Chairman EAUN

Stefano Terzoni, Chairman SCO

sponsorships and the high costs of transportation and accommodation, the EAUN offers several arrangements that make participation more affordable.

“For Munich 2016, the EAUN will provide support to a certain number of delegates, thanks to a grant from Astellas. Moreover, the 2016 programme has been divided into thematic blocks of half-days since some delegates are unable to take three full days from their hospital work.

We made it possible for them to register for one or two days, allowing many of them to participate and share with their colleagues back home the information they gained during the congress,” Terzoni said.

For details on registration and the Scientific Programme, visit the EAUN’s meeting website at: www.eaun16.org

www.eaun16.org August/September 2015