Impressions of the popular masterclasses ESU-ESUT Virtual Masterclass on

ESU highlights benign prostatic obstruction, focal therapy, prostate biopsy and partial nephrectomy

By Erika De Groot

The European School of Urology (ESU) together with the EAU Sections of Uro-Technology (ESUT), Urological Imaging (ESUI), and EAU Robotic Urology Section (ERUS) redesigned their popular masterclasses to continue elevating knowledge and skills in the time of the COVID-19 pandemic. In this article we bring you impressions and an overview of the four ESU masterclasses which took place early this year.

Vital BPO techniques and technologies Review of the current EAU Guidelines for indications for benign prostatic obstruction (BPO) surgery, introduction to different training models, semi-live demonstration of enucleation techniques, new technologies for surgical BPO therapy, and minimallyinvasive therapy options are some of the topics covered by the Virtual ESU-ESUT Masterclass on Operative management of benign prostatic obstruction which took place in April. The scientific programme was interspersed with clinical cases and lively panel discussions. Faculty member and Chairman of the Young Academic Urologists, Dr. Juan Gómez Rivas (ES) shared some of the key messages of the masterclass:

1. Use mpMRI to select target within the prostate for targeted biopsy. 2. Define a clinical cohort of patients whose tumours harbour low- to intermediate-risk characteristics without indication for surveillance and lower than those bounded for radical therapy. 3. Select energies suitable to treat and accomplish an oncologically safe organ-sparing ablation with minimum toxicity. Match the patients with energies based on tumours characteristics and location.

Participant Dr. Georgios Tsampoukas (GB) stated the benefits he attained from attending the masterclass: “The masterclass broadened my knowledge and clarified the indications regarding the applicability of the modality. It helped improve my daily practice as I can now communicate more confidently to my patients that focal therapy is an option (i.e. advantages and limitations) and find the most suitable option for them.”

The masterclass was led by internationally-known experts ESU Chairman Prof. Evangelos Liatsikos (GR), Course Directors Dr. Marcel Fiedler (DE) and ESUT Chairman Prof. Ali Serdar Gözen (DE).

When asked about his masterclass impressions, participant Dr. Lucca Brizzi (IT) shared, “The BPO masterclass gave me the desire to experiment new techniques that I don't know. I appreciate the clarity and the perfect synthesis of the speakers and the scientific content."

Fellow participant Dr. Mehrdad Mazdak (DE) described his masterclass experience as “immense”. He said, “Not only did I gain more confidence to put what I’ve learned into practice, but also received knowledge directly from the experts. One can improve one’s clinical dexterity through the ESU masterclasses, which I think are the best gateway and output of the Guidelines.”

According to participant Dr. Deimantas Šukys (LT), the knowledge he gained during the masterclass was useful in his daily practice and that he enjoyed interacting with the faculty of experts. He disclosed, “I applied for this masterclass because in my practice, I treat BPH with TURP or laparoscopic prostatectomy, and prepare for TUREP.” Fellow participant Dr. Peter Ka-Fung Chiu (HK) applied for the masterclass to learn more about focal therapy. He said, “I have some early experience in using HIFU and I would like to learn more tips and tricks and the standard recommendations on this topic.” He added that he enjoyed the case discussions and the live Q&A wherein participants were divided into small groups and supervised by top experts. Dr. Chiu said that the masterclass reminded him of proper case selection, as well as, the pros and cons of each treatment option.

Focal therapy masterclass impressions Following the BPO masterclass was the Virtual ESU-ESUT-ESUI Masterclass on Focal therapy for localised prostate cancer, which took place in May. With the support of the ESU board, Course Director Dr. Eric Barret (FR), together with ESUT Chairman Prof. Ali Serdar Gözen (DE) and ESUI Chairman Prof. Georg Salomon (DE), have successfully lead this masterclass.

The masterclass was comprised of highly informative lectures on the rationale for focal therapy, diagnostic tools for patient selection (e.g. ultrasound and MRI), treatment modalities, energy sources (e.g. cryotherapy, laser ablation, brachytherapy, etc), and focal therapy for PCa recurrence, to name a few. A focus on prostate biopsy The Virtual ESU-ESUI Masterclass on Prostate biopsy commenced in June providing participants relevant and comprehensive updates on innovations in transrectal ultrasonography, MRI (e.g. standardised reading, reporting and quality control), biomarkers in the PCa diagnosis, transperineal or transrectal approaches, fusion biopsy and more. The masterclass was led by Course Directors Prof. Lars Budäus (DE), Prof. Salomon and Dr. Jochen Walz.

The scientific programme included breakout sessions for the MRI reading course using the MIM software where participants were divided into 8 groups and received expert feedback on cases provided. Each group was supervised by a faculty member. The masterclass also offered video demonstrations on tools such as electromagnetic, image-based, mechanical and robotic navigation, and MRI-guided in-bore biopsy, to name a few.

“The impact of the masterclass to my clinical practice is this: I will be able to put into practice the information I acquired about MRI and biopsy (indication, preparation, performance and antibiotic prophylaxis), and begin the implementation of fusion biopsy in my country, the Dominican Republic,” shared participant Dr. Geraldini Castillo (DO). She added that she applied for the masterclass because it offered a complete updated programme on prostate biopsy. “My favourite part was the MRI-reading course, which I found very interesting. I learned a lot,” said Dr. Castillo.

PN masterclass demonstrates resection techniques

Whether on-site or online, ESU masterclasses are attended by enthusiastic and eager participants

Another participant, Dr. Ioannis Efthimiou (GR), also enjoyed the MRI-reading course. He stated that it was “a valuable and enjoyable experience albeit too short.” Dr. Efthimiou added that the reason he applied to the masterclass was to improve his knowledge and skills on the diagnosis of PCa using MRI. He stated that unfortunately, he cannot apply some of the strategies and techniques due to a lack of equipment at his hospital.

“My clinical practice will benefit from what I’ve learned from masterclass because it has enabled me to read prostate MRI and to make MRI a key assessment in the diagnosis of prostate cancer,” stated participant Dr. Gilles Natchagande (BJ). He said that he enjoyed the breakout sessions, as well as, the presentations on biopsy practices on the different types of fusion.

Participant Dr. Ivo Vujicik (MK) said, “I was intrigued when I heard about the masterclass from a colleague. I wanted to participate because I would like to learn more about the new techniques used for targeting prostate biopsy as I try to keep myself updated with the latest technologies as much as possible. The challenge now is how to integrate them into my clinical practice. I hope the lessons I’ve learned about accurate reading and interpretation of mp-MRI images using the MIM software will be useful in my practice.” He added that he was especially interested in the basics of fusion biopsy and the use of electromagnetic navigation. “The masterclass met my expectations because I learned a lot about the use of MRI in PCa diagnosis, the indications and the current techniques of prostate biopsy,” concluded Dr. Vujicik.

PN matters Commencing a week after the prostate biopsy masterclass is the Virtual ESU-ESUT-ERUS Masterclass on Partial nephrectomy. Spearheaded by Course Directors Dr. Alberto Breda (ES), Prof. Liatsikos and Prof. Francesco Porpiglia (IT), the masterclass tackled topics such as milestones of partial nephrectomy (PN), PN in T2 tumours, indications for open surgery, standard laparoscopy, robot-assisted laparoscopy, retro and transperitoneal approaches, and more. The programme included video sessions on maximising nephron-sparing, performing perfect enucleation, and predicting the extension of regions undergoing ischemia.

Participant Dr. Adrian Czekaj (PL) shared, “This masterclass will definitely encourage me to offer nephron-sparing and minimally-invasive treatment to patients with diagnosed kidney tumours. Unfortunately, in many countries such as Poland, the main obstacle might be the lack of universal access to the surgical robot, which facilitates the implementation of new technologies, provides a shorter learning curve and allows for the more frequent decision of using minimally-invasive technique.”

Dr. Czekaj stated that he was impressed by the presentation on the implementation of 3D-augmented virtual reality. He said, “It seems that the use of robotic surgery is an integral part of implementing new technologies and optimising oncological and functional results. I will certainly remember one of Prof. Alex Mottrie's most important principles for kidney surgery: ‘Exposure, exposure, exposure’ and the statement of another participant, who said that in laparoscopy you sew as you can, while in robotic surgery you sew as you like.”

When asked which topic/presentation made a lasting impression on him, participant Dr. Artur de Oliveira Paludo (BR) stated, “The 3D virtual models and augmented reality caught my attention because in the era of precision medicine, these tools are essential to deliver better results to our patients. For me, radiology and surgery must go together.”

According to participant Dr. Pankaj Pankaj (IN), the masterclass has provided him with new knowledge on current PN practices which he claimed will improve outcomes for this complex surgery at his centre. He said that the robot-assisted PN techniques, 3D imaging and reconstruction, and use of technology in PN were the most useful to him as these are aspects that he and his peers seek to improve at their centre.