European Urological Scholarship Programme (EUSP

I spent one wonderful year as member of the Focal Therapy team at University College London Hospital (UCLH), under the supervision of Profs Mark Emberton and Caroline Moore.

“It has been an enriching experience to spend one year surrounded by brilliant young researchers...”

Clinical activities and research This year was made possible by the EUSP. The scholarship gave me the freedom to divide my time between clinical activities and research. I had to register beforehand with the General Medical Council and prove my knowledge of English. I could attend focal therapy clinics and their multidisciplinary meetings and treat patients under supervision. Before the first lockdown, this amounted to 1.5 clinical days each week. This was reduced to one full theatre day after the lockdown, while other clinical activities were conducted remotely.

Qualitative study My research activities focused on detailing sexual outcomes after focal therapy. The aim was to set up a qualitative study to gather in-depth information on the evolution of men’s sexual function after focal therapy using HIFU, cryotherapy and irreversible electroporation. Of course, the study had to be redesigned completely to allow for remote instead of in-person interviews. This gave me the chance to conduct a systematic review and meta-analysis on existing literature. I also had the opportunity to meet with another team working on ageing and cellular senescence and to work on a review article on the role cellular senescence plays in prostatic diseases. I have been able to establish collaborations that I know will remain even now this scholarship has ended.

One of the highlights This past year has been one of the highlights in my career. It has been an enriching experience to spend one year surrounded by brilliant young researchers and to experience how research is led and organised in the UK. The clinical part of my scholarship has been incredibly useful for my future career. I have gained surgical skills in focal therapy that I will bring back to my home institution, as well as expertise in the selection, management and follow-up of patients treated with focal therapy from various energy sources. I was provided with great quality scientific guidance and very supportive feedback. It is an experience I would recommend to every young academic urologist. Thank you, EUSP board! Dr. Gaelle Fiard CHU de Grenoble Dept. of Urology Grenoble (FR)

@GaelleFiard

Best Research Scholar 2021

Dr. Ivan Lysenko Military Medical Academy Dept. of Urology St. Petersburg (RU)

ivan_lysenko@ mail.ru

New technique for MIBC studies

I will never forget my feelings of great excitement directly after my interview with the EUSP Board Committee in Munich (DE). Ten minutes later, I was filled with hope and expectations for a long-awaited new chapter in my life. Fortunately, there was someone by my side to support me: my special thanks to Angela Terberg for being so supportive and crossing her fingers for me. After two weeks I received a positive outcome, and three months later I found myself standing in front of the incredible and majestic AKH (Allgemeines Krankenhaus der Stadt Wien (AT)), one of the largest urological teaching centres in Europe - a real city within a city. I was fortunate and honoured to meet an outstanding and multinational team, remarkable people and a real family. Everyone was willing to make my onboarding process smooth and comfortable. The lessons of true leadership, all sorts of scientific ‘cooking recipes’ and, most importantly, how to be a great human being were taught to me by the Chairman of the Department of Urology, Prof. Shahrokh Shariat, who left me with lasting memories.

Muscle-invasive bladder cancer Thanks to the EUSP one-year fellowship programme, I’ve experienced great collaboration between laboratory staff and clinicians, which helped us publish our study results. Our main objective was to identify DNA damage repair (DDR) gene alteration patterns, which may predict response to neoadjuvant therapy (NAC) in muscle-invasive bladder cancer (MIBC) patients. Based on recent findings and our previous studies, we hypothesised that specific mutations in genes involved in DNA repair are associated with response or failure of NAC therapy in MIBC patients. Dr. Melanie Hassler (AT) and Dr. Andreas Bruchbacher (AT) kindly shared their knowledge and experience with me and assisted me in developing a laboratory research activity which allows us to carry out nearly every study in a modern, high-level fashion.

Further validation After performing these experiments with the help of an NGS sequencing method, we concluded that genomic alterations in DNA repair genes, such as BRCA1, BRCA2, ERCC2 and CDK12, may predict response to cisplatin-based NAC in MIBC patients (p = 0.001). Results from the current study outlined future concepts. They are followed by further analysis with much greater external, large-scale validation of this finding, which is ongoing. I was incredibly lucky to embark on this challenging journey full of lessons and new discoveries, spend time at the Medical University of Vienna and have access to all its research and clinical facilities. Regardless of how much effort and time it takes, I would definitely encourage applicants to strive for the EUSP fellowship grant at some point in their career.

Fellows posing with Prof. Shariat

Endoscopic surgery skills improved

Dr. Begoña Ballesta Martínez Royal Perth Hospital Perth (AU)

bballestamartinez@ gmail.com

I have recently completed the EAU EULIS EUSP Fellowship in the General University Hospital of Patras (GR) hosted by Prof. Evangelos Liatsikos. When I applied for this programme, I intended to complete my fellowship working with experts in laparoscopy and endourology.

Research team The programme consisted of observing, assisting in and completing some steps in a large number of endoscopic surgery sessions, mostly based on urinary stones treatment and BPH management, besides laparoscopic procedures. It included collaborating with a research team at the University of Patras under the guidance of Profs. Evangelos Liatsikos and Panagiotis Kallidonis.

The number of some surgical procedures fell slightly as a result of Covid-19 in Greece. However, the team is surgically, academically and personally outstanding; a game-changing group of experts. We performed between 6 and 10 endoscopic cases per day including PCNLs, ECIRSs, RIRSs and URSs.

Procedures During my three months in Patras, I performed the access of 5 PCNLs, 5 RIRS, 2 for the treatment of upper urinary tract tumours, 6 URS and 4 cystolithotripsy of big stones. I assisted in 14 PCNLs, 20 RIRS-5 UTUC-, 12 URS, 1 ECIRS, 1 cystolithotripsy. I observed a great deal of endoscopic procedures of all types. I performed steps in 3 nerve-sparing radical prostatectomies and

With the team at the General University Hospital of Patras

assisted in more than 20 cases. Although these were not the specialisation subjects of the fellowship, I also assisted in 12 open surgery sessions including radical cystectomies + Bricker, radical prostatectomies, radical and partial nephrectomies and 1 ureterectomy. We had research meetings on a monthly basis.

The specialisation in this EAU EULIS EUSP fellowship in Patras will remain present in my clinical practice forever. I learnt how important standardisation is in surgery. The comments from the experts were extremely useful, and they will be part of my ‘building blocks’ as I continue to practice in this field. Additionally, the research work was the best way to understand that research is absolutely essential in order to comprehend the diseases we treat, the technology we use and the surgical techniques we employ and perhaps improve.

Another useful aspect was the experience I gained by using the most innovative and high-tech equipment from different manufacturers. However, the most important gift was getting to know Prof. Liatsikos and his team. The way they think and how they tackle surgery and science changed my vision on urology forever. I strongly encourage younger people to work hard, enjoy learning, give their all and be present in as many surgery sessions as they can. I would recommend that they enrol in an internationally recognised fellowship programme in their favourite urological area. I am very thankful to the EAU, the EUSP, the EULIS, Prof. Mirone, Prof. Sarica, Prof. Liatsikos, Prof. Kallidonis and the whole team in Patras for the unique opportunity.

Dr. Sanchez Guerrero enjoys challenging fellowship in France

Dr. Clara Sanchez Guerrero Hospital Universitario Ramón y Cajal Dept. of Urology Madrid (ES)

csguerrero9@ gmail.com

L’hôpital de la Pitié Salpetrière in Paris is the largest hospital in France. The first Hôpitaux Général were built in the 17th century. Home to several famous doctors, such as Profs. Charcot and Babinski, the hospital nowadays has 90 buildings and is a reference centre for numerous pathologies. The department of urology, led by Professor Emmanuel Chartier-Kastler, is not only a leading centre in functional urology and neurourology, but also in oncological and robot-assisted surgery. Timetable My week’s activities at the neurourology and functional urology section were as follows: • Monday: consultation and endoscopies; highly specialised consultations for diagnosis, follow-up and post-operatory visits. • Tuesday: operating room. At 17.30 hrs, the multidisciplinary meeting for urological cancers was held. • Wednesday: consultation with Professor

Veronique Phé. As on Monday, this was a specialised consultation for the treatment of neurological patients. • Thursday: robot-assisted surgery. • Friday: I visited the Raymond Pointcaré handicap hospital. It is a reference centre for neurological disease rehabilitation.

Surgical activity I was able to attend numerous stress urinary incontinence surgery sessions. In addition, I witnessed the use of techniques such as ProAct ® implantation and Bulkamid® injection for the first time. I learned how to perform a supratrigonal augmentation

The team with me and Prof. Chartier-Kastler on the right

enterocystoplasty and how to use different techniques of urinary continent diversion. I attended a robotassisted and open promontofixation for the treatment of pelvic organ prolapse.

Outpatient clinic My visit to the outpatient clinic was useful, since one of my main objectives was to learn how to manage urinary tract symptoms in patients with neurological diseases. Consultation is very well organised at the clinic. It is possible to perform physical exploration, endoscopies and flowmetry. The team of nurses was magnificent. They were a great support when diagnostic tests were being performed on patients. They also taught patients how to do intermittent catheterisation and stoma management.

Covid-19 The Covid-19 pandemic was very present. Hospitalisation beds were closed and surgical activities were reduced by the end of my visit. However, I do not think this situation was a handicap; I accomplished all the learning objectives I proposed.

My clinical stay has changed my view on neurourology and the importance of collaboration between medical departments. I had the opportunity to get to know interns, fellows and urologists from different countries and it was very interesting to share different ways to work.