EAU Guidelines Office: The year in review

By the previous Chair and Vice-Chair of the Guidelines Office Board

Over the course of the past year and a half, we have faced a truly unprecedented healthcare crisis. The COVID-19 pandemic has tested the resources and capacity of health systems around the world and our normal working patterns have been radically altered. Despite these challenges, the EAU Guidelines Office has continued to function and in April we were honoured to present the 2021 edition of the European Association of Urology (EAU) Guidelines. We would like to take this opportunity to thank all members of the Guidelines Office who have worked tirelessly during this period to make this update possible.

Last year an additional burden was placed on panel members over and above the yearly update of the EAU Guidelines. In response to the COVID-19 pandemic, a Guidelines Office Rapid Reaction Group (GORRG) composed of highly experienced Board and panel members was established. The GORRG groups’ initial remit was to provide rapid guidance, underpinned by the best knowledge available, on adapting EAU Guidelines recommendations to the COVID-19 pandemic. Thanks to the efforts of all panel members, the publication of the “EAU Adapted Guidelines for the COVID-19 Era” was achieved in a very short period and published in April 2020. Moving forward, the GORRG will expand on their initial remit to address a wider range of important topics directly impacting urological practice.

For the 2021 edition of the EAU Guidelines, we were proud to present two new EAU Guidelines: one addressing Non-Neurogenic Female Lower Urinary Tract Symptoms (LUTS) and one addressing Urethral Strictures. The Guidelines on Non-Neurogenic Female LUTS provide a concise overview of the evidence-base related to assessment and treatment of female LUTS as reflected in clinical practice and expands on the previous EAU Incontinence Guideline. The Guidelines on Urethral Strictures aim to provide a comprehensive overview of urethral strictures management in male, female and transgender patients. In addition, a number of Guidelines have added new sections for 2021 including: • Sexual and Reproductive Health – new section on

Priapism • Urological Infections – new section on the

Management of HPV in Males • Paediatric Urology – new sections on Testicular

Tumours in prepubertal boys and Rare Conditions covering urachal remnants, papillary tumours of the bladder and penile rare conditions

The “Summaries of changes” sections detail the updates achieved for the various guidelines.

In the first 4 weeks after publication more than 300,000 Guidelines website sessions were generated on Uroweb with 28,000 downloads of the Guidelines pdfs in the first 7 days! Top 6 downloads to date: Prostate Cancer; Renal Cell Carcinoma; Urological Infections; Urolithiasis; Muscle-invasive Bladder Cancer; and Non-neurogenic Male LUTS.

“In the first 4 weeks after publication more than 300,000 guidelines website sessions were generated on Uroweb.org with 28,000 downloads of the Guidelines PDFs in the first 7 days!”

We are excited to announce a new ASCO-EAU Penile Cancer Guidelines Panel. A fully collaborative multi-disciplinary panel has been set up, led by two co-chairs Prof. S.T. Tagawa (ASCO) and Dr. O. Brouwer (EAU). The aim of the panel is to develop a completely new guideline, fully engaging patients in this process. The first systematic review is under way and the new Guidelines will be published in the 2022 edition of the Guidelines.

On behalf of the EAU Guidelines Office Board, we would like to take this opportunity to thank the wider EAU membership for your support and inspiration. We hope you are enjoying using the 2021 update of the EAU Guidelines and we look forward to a brighter 2022. Are you interested in joining the PIONEER initiative? Then please take our short 3-minute survey: https://bit.ly/3ytvwLS.

New Chair of the Guidelines Office

Prof. Maria Ribal

It is with great pleasure that we announce that the appointment of Professor Maria Ribal as the new Chair of the Guidelines Office Board was confirmed at the General Assembly of the EAU21 Virtual Congress.

We wish her all the very best with her appointment and future as the Chair of the Guidelines Office!

New EAU Urethral Strictures Panel

By Prof. Nicolaas Lumen, Chair of the panel

Although a common pathology in urologic practice, it took until 2021 before urethral stricture disease (USD) was introduced as a stand-alone guidelines topic within the EAU guidelines. The Strictures Panel (a mix of clinical experts, methodologists and promising urologists with specific interest in USD) aimed to handle all aspects of urethral strictures. Therefore, it contains not only recommendations on treatment of USD, but also on prevention, diagnosis, peri-operative care and follow-up. In addition, included are recommendations on male USD, female USD and strictures in transgender patients. Therefore, to the best of our knowledge, these guidelines are the most comprehensive currently available. The guidelines are based on a structured literature search ranging from 2008-2018 with selection of articles based on well-defined inclusion and exclusion criteria. To strengthen recommendations, two systematic reviews have been performed and one is ongoing by our team of associates. Although level of evidence in the field of USD is low, trials are running or have been recently performed to improve the quality of available data, an effort fully encouraged by the Urethral Strictures panel. Within the EAU Urethral Strictures Guideline you will find the necessary clinical practice guidelines to optimise the treatment of the individual patient with USD in urologic practice.

Call to action: PIONEER Patient-Reported Outcome Measures

Prostate Cancer (PCa) is characterised by a relatively long natural history, where a substantial proportion of PCa patients die from causes other than the disease itself. As a result of this there is an increasing awareness of the importance of measuring treatmentrelated side effects as well as Health-Related Quality of Life (HRQoL) using Patient-Reported Outcome Measures (PROMs). This is essential when considering that cancer patients have the possibility of trading HRQoL for length of life.

Patient-reported outcome measures ask patients to assess elements of their own health, quality of life, and functioning. The resulting data can be used to show how healthcare interventions and treatments affect these aspects of a person’s day-to-day life.

Evidence to support the use of PROMs to improve the quality of care received by patients is growing, supported by the realisation that patients are the best judges of the impact of their treatment on their pain, daily functioning, symptoms and quality of life. For clinicians PROMs are a valuable support tool for shared decision making with a patient-centred focus. However, it is important to use valid, reliable and appropriate instruments when selecting PROMs that also minimise the burden placed on patients and healthcare workers for data collection.

Within PIONEER we are actively working to assess the validity of PROMs currently used for assessing different domains (i.e., urinary, sexual, and bowel function) and quality of life in patients with PCa. One of PIONEER’s overarching goals is to develop both standard core outcome sets (COSs) and PROMs, to guide the selection of the most appropriate COSs and PROMs to use for assessment of outcomes in patients with PCa in routine care and research.

To achieve this goal we would like to begin by identifying which PROMs are used in daily clinical practice, and to identify potential new data holders and collaborators. Do you have PCa PROMs data? Big Data 4 Better Outcomes: Recommendations for the European Health Data Space

Coordinated by PIONEER the five Big Data 4 Better Outcomes (BD4BO) projects of the Innovative Medicines Initiative have joined forces to develop a number of joint recommendations to inform EU decision makers in order to respond to the public consultation on the European Health Data Space (EHDS). Read the full set of BD4BO recommendations on the EHDS website.

PIONEER welcomes new consortium partner The Centre for Advanced Systems Understanding (CASUS) at the Helmholtz-Zentrum Dresden-Rossendorf (HZDR) and PIONEER ally in the fight against prostate cancer. CASUS takes over the task of providing a new centralised data and analytics platform for PIONEER. The cloud-based platform will provide data access and machine learning analytics capabilities for both academia and industry researchers.

Besides providing the PIONEER Big Data Platform cloud infrastructure, CASUS will also set up and support federated data analysis for all members of the consortium. For Dr. Michael Bussmann, Scientific Head of the Görlitz (Germany)-based research centre, this aspect is of paramount importance: “By developing advanced machine learning algorithms, we expect to come up with better predictive models of patient outcomes and disease progression. The focus is on established and new clinical and biological indicators, so-called biomarkers. We will try to find out if and how recording such biomarkers improves predictions throughout a prostate cancer patient’s care pathway”.

For any questions, please contact e.smith@uroweb.org

The EAU Podcast is coming soon!

Looking for informative podcasts on urology?

The EAU presents its new series of podcasts covering a wide range of topics. From Guidelines updates to practical tips in daily practice, we aim to cover it all!

Listen whenever, wherever EAU21 Annual Congress attracts global audience ........................... 1

EAU Guidelines Office: The year in review ... 3

Practical answers to testicular microlithiasis mysteries ........................... 4

Green light for the EAU Policy Office ........6

ERN eUROGEN: Update from the Network for Rare Urology .......................6

Clinical challenge ......................7

Key articles from international medical journals ................... 10-13

ESU section: Impressions of the popular masterclasses. . . 16 ESU-ESUT Virtual Masterclass on Urolithiasis .......................... 17 UUA congress and the virtual ESU course ... 17 Refresh and test your EAU Guidelines knowledge .......................... 18

ESUI: Selecting imaging modality to follow up drug response ............... 22

EAU RF section: MARS: Management of priapism and impact on outcomes .................. 29 ROGUE-1: Multicentric, prospective T1 BCa registry ...................... 29

ESUT: Ablative therapy for renal masses: Present and future .................... 31

European Urological Scholarship Programme (EUSP) ................... 32

A new glimpse into urology in the 16th century ........................ 33

ESGURS: Controversies in early post-op imaging after urethroplasty ............ 35

The latest news from the YAU Office ...... 37 New YAU working group kidney transplantation ...................... 37

“Long-term and sustained improvements is the goal” ......................... 43

ESTU: Recipient selection for kidney transplantation ...................... 44

Obituary Prof. Louis Denis. . . . . . . . . . . . . . 45

Book review ........................ 45

EAUN section: Provision of advanced uro-oncological care .............................. 47 EAUN: Latest developments ............ 48